Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003177387 |
---|---|
Provider Name | Mr. Brian P Shea |
First Address | Providence, RI 02903-1177 |
Second Address | Providence, RI 02903-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 04/06/2012 |