Provider Demographics
NPI:1023150224
Name:SHANNON, NANCY (LMHC, LMFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 OAK NECK RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-4552
Mailing Address - Country:US
Mailing Address - Phone:781-585-8348
Mailing Address - Fax:
Practice Address - Street 1:16 WATERHOUSE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3897
Practice Address - Country:US
Practice Address - Phone:781-585-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3442101YM0800X
903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health