Provider Demographics
NPI:1588541106
Name:FISHER, SHANNON MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:RAVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1465 WHITE DEER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9244
Mailing Address - Country:US
Mailing Address - Phone:570-204-2337
Mailing Address - Fax:
Practice Address - Street 1:1465 WHITE DEER PIKE
Practice Address - Street 2:
Practice Address - City:NEW COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17856-9244
Practice Address - Country:US
Practice Address - Phone:570-204-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW023133101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor