Provider Demographics
NPI:1366818510
Name:SHANNON, LAURI A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:A
Last Name:SHANNON
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 1:34931 US HIGHWAY 19 N STE 116
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1923
Mailing Address - Country:US
Mailing Address - Phone:786-423-6787
Mailing Address - Fax:844-556-4651
Practice Address - Street 1:34931 US HIGHWAY 19 N STE 116117
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1913
Practice Address - Country:US
Practice Address - Phone:786-423-6787
Practice Address - Fax:844-556-4651
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW127171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical