Provider Demographics
NPI:1558982900
Name:KINSELLA, SHANNON (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18
Mailing Address - Street 2:GREENE LN
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18
Practice Address - Street 2:GREENE LN
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-0284
Practice Address - Country:US
Practice Address - Phone:860-205-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health