Provider Demographics
NPI:1154139376
Name:HANRAHAN, SHANNON (LSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08752-1407
Mailing Address - Country:US
Mailing Address - Phone:215-933-8773
Mailing Address - Fax:
Practice Address - Street 1:2400 ROUTE 88 FL 2
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2247
Practice Address - Country:US
Practice Address - Phone:732-709-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07154400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker