Provider Demographics
NPI:1487360608
Name:FORESHEE, SHANNON FORESHEE LEE (LMSW)
Entity type:Individual
Prefix:MR
First Name:SHANNON FORESHEE
Middle Name:LEE
Last Name:FORESHEE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BRYSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1922
Mailing Address - Country:US
Mailing Address - Phone:917-697-0311
Mailing Address - Fax:
Practice Address - Street 1:201 BRYSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1922
Practice Address - Country:US
Practice Address - Phone:917-697-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112273-01101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health