Provider Demographics
NPI:1386892271
Name:DAVIDENKO, SHANNON J (LMHC)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:J
Last Name:DAVIDENKO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:J
Other - Last Name:LECOMPTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:89 ACCESS RD STE 24
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5233
Mailing Address - Country:US
Mailing Address - Phone:781-551-0999
Mailing Address - Fax:781-551-3396
Practice Address - Street 1:44 BEARFOOT RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1559
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:781-551-3396
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health