Provider Demographics
NPI:1063154425
Name:CAFFREY, SHAUNA (LICSW)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:CAFFREY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 SOMERVILLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3350
Mailing Address - Country:US
Mailing Address - Phone:716-912-2801
Mailing Address - Fax:
Practice Address - Street 1:409 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-0933
Practice Address - Country:US
Practice Address - Phone:800-529-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW127622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker