Provider Demographics
NPI:1285042200
Name:NICHOLSON, SHANNON NORMA (MSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NORMA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NORMA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:44 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4915
Mailing Address - Country:US
Mailing Address - Phone:843-655-4022
Mailing Address - Fax:
Practice Address - Street 1:75 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6528
Practice Address - Country:US
Practice Address - Phone:203-721-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker