Provider Demographics
NPI:1972041614
Name:EMMANUEL, SHANNON (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:EMMANUEL
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PEARL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1847
Mailing Address - Country:US
Mailing Address - Phone:862-259-5180
Mailing Address - Fax:
Practice Address - Street 1:16 PEARL ST STE 102
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1962
Practice Address - Country:US
Practice Address - Phone:862-259-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00243400101YA0400X
NJ44SC056194001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)