Doctor Name: | CHER A SHANNON |
NPI Number: | 1073632014 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHSA, LADC SAP |
License Number: | 000289 |
Business Practice Address: | 121 Mount Pleasant Rd Newtown, CT - 064701537 |
Business Phone Number: | 2034268103 |
Business Fax Number: | 2034260550 |
Mailing Address: | 121 Mount Pleasant Rd, NEWTOWN |
State: | CT |
Postal Code: | 064701537 |
Phone Number: | 2034268103 |
Fax Number: | 2034260550 |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 000289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |