Provider Demographics
NPI:1518568203
Name:SMITH, SHANNON (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:WOERTHMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 NEWPORT CT
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3944
Mailing Address - Country:US
Mailing Address - Phone:609-906-3010
Mailing Address - Fax:
Practice Address - Street 1:99 HUCKLEBERRY CT
Practice Address - Street 2:
Practice Address - City:THREE BRIDGES
Practice Address - State:NJ
Practice Address - Zip Code:08887-2109
Practice Address - Country:US
Practice Address - Phone:908-994-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00417900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty