Provider Demographics
NPI:1225347248
Name:FOLEY, SHANNON (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:FOLEY
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 9TH ST
Mailing Address - Street 2:3
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2546
Mailing Address - Country:US
Mailing Address - Phone:339-440-3346
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD
Practice Address - Street 2:209
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5177
Practice Address - Country:US
Practice Address - Phone:339-440-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 213698-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical