Provider Demographics
NPI:1124158217
Name:MCINTYRE, SHANNON LINDSAY (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LINDSAY
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6025
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-6025
Mailing Address - Country:US
Mailing Address - Phone:925-330-2287
Mailing Address - Fax:
Practice Address - Street 1:17 ELM ST STE C
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-0370
Practice Address - Country:US
Practice Address - Phone:802-451-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor