Provider Demographics
NPI:1548616683
Name:SHANNON, JOLYNNE Z (LCSW)
Entity Type:Individual
Prefix:
First Name:JOLYNNE
Middle Name:Z
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 1:1142 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1574
Mailing Address - Country:US
Mailing Address - Phone:717-269-6451
Mailing Address - Fax:
Practice Address - Street 1:1142 HARVEST DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-1574
Practice Address - Country:US
Practice Address - Phone:717-269-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0185091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical