Doctor Name: | SHANNON NICOLE CORNELL |
NPI Number: | 1669734687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 483 Fordham Rd Wenonah, NJ - 080901227 |
Business Phone Number: | 8568891505 |
Business Fax Number: | |
Mailing Address: | 483 Fordham Rd, WENONAH |
State: | NJ |
Postal Code: | 080901227 |
Phone Number: | 8568891505 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2012 |
NPI Last Update Date: | 02/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |