Provider Demographics
NPI:1861617649
Name:SHAPIRO, JODIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WALTER ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1521
Mailing Address - Country:US
Mailing Address - Phone:617-323-8480
Mailing Address - Fax:
Practice Address - Street 1:1832 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1901
Practice Address - Country:US
Practice Address - Phone:617-323-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4574103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4476OtherBLUE CROSS BLUE SHIELD ID
MAWO4476OtherBLUE CROSS BLUE SHIELD ID