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NPI Code Detail

MEDICARE: KENNETH E SHINDELMAN LICSW

MEDICARE: KENNETH E SHINDELMAN LICSW
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
11041C0700XClinical Social Worker111566MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P08372OTHERMABCBS

General Provider Information

NPI Number : 1639250509
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH E SHINDELMAN LICSW
Provider Business Mailing Address
First Line : 115 MILL ST
Second Line :
City : BELMONT
State : MA
Zip : 02478-1041
Country : US
Telephone Number : 617-855-3332
Fax Number :
Provider Business Practice Location Address
First Line : 22 MILL ST
Second Line : STE 405
City : ARLINGTON
State : MA
Zip : 02476-4744
Country : US
Telephone Number : 617-855-3332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 08/29/2018

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Directions to “ KENNETH E SHINDELMAN LICSW” Practice Location

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