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NPI Code Detail

MEDICARE: SARA SHINE

MEDICARE: SARA SHINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144429028
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA SHINE
Provider Business Mailing Address
First Line : 77B WARREN ST
Second Line : BAMHA
City : BRIGHTON
State : MA
Zip : 02135
Country : US
Telephone Number : 617-787-1901
Fax Number : 617-254-3461
Provider Business Practice Location Address
First Line : 1125 CENTRE ST
Second Line : ST ITALIAN HOME
City : JAMAICA PLAIN
State : MA
Zip : 02130-3445
Country : US
Telephone Number : 617-787-1901
Fax Number : 617-254-3461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2007
Last Update Date : 07/12/2007

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Directions to “ SARA SHINE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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