Provider Demographics
NPI:1336868009
Name:FISHEL, SHANNA T (LICSW)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:T
Last Name:FISHEL
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 1:236 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9772
Mailing Address - Country:US
Mailing Address - Phone:413-561-7270
Mailing Address - Fax:
Practice Address - Street 1:116 PLEASANT ST STE 320
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2756
Practice Address - Country:US
Practice Address - Phone:415-561-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1251881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical