| Doctor Name: | MS. SHANTAYA CLARA FONSECA |
| NPI Number: | 1073852448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | |
| Business Practice Address: | 541 Main St Suite 303 Weymouth, MA - 021901868 |
| Business Phone Number: | 7813317866 |
| Business Fax Number: | |
| Mailing Address: | 541 Main Street, Suite 303 WEYMOUTH |
| State: | MA |
| Postal Code: | 02190 |
| Phone Number: | 7813317866 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2013 |
| NPI Last Update Date: | 02/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |