Provider Demographics
NPI:1770856114
Name:SHINE-O'BRIEN, KATHLEEN C (LMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:SHINE-O'BRIEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TELEGRAPH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2347
Mailing Address - Country:US
Mailing Address - Phone:508-274-4018
Mailing Address - Fax:
Practice Address - Street 1:331 COTUIT RD
Practice Address - Street 2:#31
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2434
Practice Address - Country:US
Practice Address - Phone:508-274-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health