Provider Demographics
NPI:1487952495
Name:SHANAHAN, KRISTINE J (MED)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:J
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2728
Mailing Address - Country:US
Mailing Address - Phone:508-528-8918
Mailing Address - Fax:508-528-8918
Practice Address - Street 1:6 ROYAL CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2728
Practice Address - Country:US
Practice Address - Phone:508-528-8918
Practice Address - Fax:508-528-8918
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health