Provider Demographics
NPI:1154890796
Name:MOONEY, SHANNON QUINN (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:QUINN
Last Name:MOONEY
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 1:8 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1817
Mailing Address - Country:US
Mailing Address - Phone:860-808-6677
Mailing Address - Fax:
Practice Address - Street 1:8 LOWELL RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1817
Practice Address - Country:US
Practice Address - Phone:860-808-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3884101YM0800X
CT0105031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health