Provider Demographics
NPI:1306455142
Name:PEDZEWICK, SHELBY (LICSW)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:PEDZEWICK
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 1:100 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2468
Mailing Address - Country:US
Mailing Address - Phone:508-846-2221
Mailing Address - Fax:
Practice Address - Street 1:720 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2369
Practice Address - Country:US
Practice Address - Phone:781-924-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No104100000XBehavioral Health & Social Service ProvidersSocial Worker