Provider Demographics
NPI:1861676660
Name:GUILLEMETTE, SHAWN (MED; LSW)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GUILLEMETTE
Suffix:
Gender:M
Credentials:MED; LSW
Other - Prefix:MR
Other - First Name:SHAWN
Other - Middle Name:PAUL
Other - Last Name:GUILLEMETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED; LSW
Mailing Address - Street 1:543 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2766
Mailing Address - Country:US
Mailing Address - Phone:508-996-3154
Mailing Address - Fax:
Practice Address - Street 1:543 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2766
Practice Address - Country:US
Practice Address - Phone:508-996-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4104611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical