Provider Demographics
NPI:1558306639
Name:BON-SHANNON, ADELE C (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:C
Last Name:BON-SHANNON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-866-2744
Mailing Address - Fax:610-282-3795
Practice Address - Street 1:701 W BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-866-2744
Practice Address - Fax:610-282-3795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW00128521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2318645000OtherINDEP BL CROSS
PA01996901OtherCAPITAL BL CROSS
PA2318645000OtherINDEP BL CROSS