Provider Demographics
NPI:1306538475
Name:CAHILL, SHANNON MARIE (LAC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:CAHILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:28 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1609
Mailing Address - Country:US
Mailing Address - Phone:917-789-2270
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE RD STE 3B
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1273
Practice Address - Country:US
Practice Address - Phone:732-724-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00697200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health