Provider Demographics
NPI:1336651413
Name:LANCELLOTTI, SHANNON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:LANCELLOTTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2942
Mailing Address - Country:US
Mailing Address - Phone:732-713-2484
Mailing Address - Fax:
Practice Address - Street 1:17 BRANT AVE STE 3
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1548
Practice Address - Country:US
Practice Address - Phone:732-713-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046024001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical