Provider Demographics
NPI:1306038633
Name:SHANNON, HAYWOOD SCOTT
Entity Type:Individual
Prefix:MR
First Name:HAYWOOD
Middle Name:SCOTT
Last Name:SHANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:30 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1809
Mailing Address - Country:US
Mailing Address - Phone:978-620-1709
Mailing Address - Fax:978-683-6074
Practice Address - Street 1:30 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1809
Practice Address - Country:US
Practice Address - Phone:978-620-1709
Practice Address - Fax:978-683-6074
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor