MEDICARE: EVAN SHOPPER

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1629226642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN SHOPPER

Provider Business Mailing Address
First Line	:	238 MAIN ST
Second Line	:	FOURTH FLOOR
City	:	GREENFIELD
State	:	MA
Zip	:	01301-3243
Country	:	US
Telephone Number	:	413-774-6252
Fax Number	:	413-773-0477

Provider Business Practice Location Address
First Line	:	238 MAIN ST
Second Line	:	FOURTH FLOOR
City	:	GREENFIELD
State	:	MA
Zip	:	01301-3243
Country	:	US
Telephone Number	:	413-774-6252
Fax Number	:	413-773-0477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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Directions to “ EVAN SHOPPER ” Practice Location

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