Provider Demographics
NPI:1124516596
Name:FRANCH, SHANNON TERESA (LICSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:TERESA
Last Name:FRANCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2066
Mailing Address - Country:US
Mailing Address - Phone:508-894-3733
Mailing Address - Fax:508-559-7695
Practice Address - Street 1:110 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2066
Practice Address - Country:US
Practice Address - Phone:508-894-3733
Practice Address - Fax:508-559-7695
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker