Provider Demographics
NPI:1366315780
Name:SHIPLEY, JAMAUL ALLEN
Entity type:Individual
Prefix:
First Name:JAMAUL
Middle Name:ALLEN
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-5510
Mailing Address - Country:US
Mailing Address - Phone:508-304-3134
Mailing Address - Fax:
Practice Address - Street 1:108 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-5510
Practice Address - Country:US
Practice Address - Phone:508-304-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty