Provider Demographics
NPI:1619847779
Name:SHANNON NOLEN, SHANNON NOLEN ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:SHANNON NOLEN
Middle Name:ELIZABETH
Last Name:SHANNON NOLEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BRENN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-2009
Mailing Address - Country:US
Mailing Address - Phone:212-481-4040
Mailing Address - Fax:240-360-2637
Practice Address - Street 1:34 BRENN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-2009
Practice Address - Country:US
Practice Address - Phone:212-481-4040
Practice Address - Fax:240-360-2637
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABACB687232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty