Provider Demographics
NPI:1598005845
Name:TREWORGY, SHANNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:
Last Name:TREWORGY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2075
Mailing Address - Country:US
Mailing Address - Phone:603-277-9110
Mailing Address - Fax:603-277-9154
Practice Address - Street 1:23 S MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2075
Practice Address - Country:US
Practice Address - Phone:603-277-9110
Practice Address - Fax:603-277-9154
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical