MEDICARE: MS. MARYLOU E. SHEARING M.S.W.

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	1041C0700X	Clinical Social Worker	105297	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2078990	OTHER	MA	CIGNA/GUARDIAN PROV. NUMB
2	453450	OTHER	MA	TUFTS PROVIDER NUMBER
3	1005325	OTHER	MA	FALLON/NHP PROVIDER NUMBE
4	151805	OTHER	MA	VALUE OPTIONS/TRICARE/CHA
5	109603	OTHER	MA	HMO BLUE NUMBER
6	007377	OTHER	MA	HARVARD PILGRIM HEALTHCAR

General Provider Information

NPI Number	:	1821108705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYLOU E. SHEARING M.S.W.

Provider Business Mailing Address
First Line	:	455 W CENTER ST
Second Line	:	SUITE 3 BOX 1
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1637
Country	:	US
Telephone Number	:	508-954-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 W CENTER ST
Second Line	:	SUITE 3 BOX 1
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1637
Country	:	US
Telephone Number	:	508-954-4431
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/15/2008

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