Provider Demographics
NPI:1407232853
Name:MONTY, SHANNON (LADC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MONTY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-4208
Mailing Address - Country:US
Mailing Address - Phone:518-499-0259
Mailing Address - Fax:
Practice Address - Street 1:56 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887-4208
Practice Address - Country:US
Practice Address - Phone:518-499-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)