MEDICARE: SUZANNE BRUSHART-SHAW LMHC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891942462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE BRUSHART-SHAW LMHC

Provider Business Mailing Address
First Line	:	51 LINCOLN AVE
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-2124
Country	:	US
Telephone Number	:	401-263-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 WASHINGTON RD
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-1864
Country	:	US
Telephone Number	:	401-263-3945
Fax Number	:

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	12/21/2022

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