Provider Demographics
NPI:1073869665
Name:HARRIS, SHANNON NICOLE (BS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3032
Mailing Address - Country:US
Mailing Address - Phone:561-275-0669
Mailing Address - Fax:
Practice Address - Street 1:521 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3032
Practice Address - Country:US
Practice Address - Phone:561-275-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker