Provider Demographics
NPI:1467827964
Name:SHEBAIRO, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SHEBAIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THATCHER ST
Mailing Address - Street 2:#1A
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3577
Mailing Address - Country:US
Mailing Address - Phone:617-797-8376
Mailing Address - Fax:
Practice Address - Street 1:25 THATCHER ST
Practice Address - Street 2:#1A
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3577
Practice Address - Country:US
Practice Address - Phone:617-797-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1143971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical