Provider Demographics
NPI:1346436524
Name:RECUPERO, SHANNON RAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RAE
Last Name:RECUPERO
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:300 E HOSPITAL RD
Mailing Address - Street 2:ROOM 13A-10
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-9054
Mailing Address - Fax:706-787-8991
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:ROOM 13A-10
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-9054
Practice Address - Fax:706-787-8991
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0037771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical