MEDICARE: SHELBY MILLS

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649638610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY MILLS

Provider Business Mailing Address
First Line	:	1046 CENTRAL ST
Second Line	:
City	:	EAST BRIDGEWATER
State	:	MA
Zip	:	02333-2140
Country	:	US
Telephone Number	:	508-649-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 CENTRAL ST
Second Line	:
City	:	EAST BRIDGEWATER
State	:	MA
Zip	:	02333-2140
Country	:	US
Telephone Number	:	508-649-0013
Fax Number	:

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

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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Directions to “ SHELBY MILLS ” Practice Location

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