Provider Demographics
NPI:1215122700
Name:SHANNON, HENRIETTA LAWLER (LCSW)
Entity type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:LAWLER
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:HENRIETTA
Other - Middle Name:LAWLER
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 WATSON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12494-5431
Mailing Address - Country:US
Mailing Address - Phone:917-302-7657
Mailing Address - Fax:
Practice Address - Street 1:821 WATSON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WEST SHOKAN
Practice Address - State:NY
Practice Address - Zip Code:12494-5431
Practice Address - Country:US
Practice Address - Phone:917-302-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053605001041C0700X
NY076171-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical