Doctor Name: | T.LEE SHOSTACK |
NPI Number: | 1013298827 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | |
Business Practice Address: | 55 Dimock St Outpatient Addiction And Recovery Services Roxbury, MA - 021191029 |
Business Phone Number: | 6174488800 |
Business Fax Number: | |
Mailing Address: | 55 Dimock St, Outpatient Addiction And Recovery Services ROXBURY |
State: | MA |
Postal Code: | 021191029 |
Phone Number: | 6174488800 |
Fax Number: | |
NPI Enumeration Date: | 09/07/2011 |
NPI Last Update Date: | 04/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |