Provider Demographics
NPI:1447739248
Name:FERRELLI, SHANNON (LICSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FERRELLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4557
Mailing Address - Country:US
Mailing Address - Phone:603-475-5061
Mailing Address - Fax:
Practice Address - Street 1:365 W MEADOW RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1312
Practice Address - Country:US
Practice Address - Phone:978-446-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool