Provider Demographics
NPI:1710697438
Name:COOPER, SHANNON LEIGHANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGHANNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:LEIGHANNE
Other - Last Name:POLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:29 BREEZY ACRES
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:ME
Mailing Address - Zip Code:04352-3534
Mailing Address - Country:US
Mailing Address - Phone:207-557-1033
Mailing Address - Fax:
Practice Address - Street 1:29 BREEZY ACRES
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:ME
Practice Address - Zip Code:04352-3534
Practice Address - Country:US
Practice Address - Phone:207-994-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC253151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical