Provider Demographics
NPI:1225752900
Name:CARROLL, SHANNON MARIE (MHC)
Entity Type:Individual
Prefix:
First Name:SHANNON MARIE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 ROUTE 376 STE 201
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6493
Mailing Address - Country:US
Mailing Address - Phone:845-765-2366
Mailing Address - Fax:
Practice Address - Street 1:942 ROUTE 376 STE 201
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6493
Practice Address - Country:US
Practice Address - Phone:845-765-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health