Provider Demographics
NPI:1063744092
Name:THILL, SHANNON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:THILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 LAKE SERENA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-6509
Mailing Address - Country:US
Mailing Address - Phone:954-296-4120
Mailing Address - Fax:
Practice Address - Street 1:9395 LAKE SERENA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-6509
Practice Address - Country:US
Practice Address - Phone:954-296-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical