Provider Demographics
NPI:1598405177
Name:VIGNOLA, SHANNON C (LP MHC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:C
Last Name:VIGNOLA
Suffix:
Gender:F
Credentials:LP MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2106
Mailing Address - Country:US
Mailing Address - Phone:516-344-7354
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2739
Practice Address - Country:US
Practice Address - Phone:516-619-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health