Provider Demographics
NPI:1619515202
Name:MCGUINNESS, SHANNON ANN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANN
Last Name:MCGUINNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SILVERLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1627
Mailing Address - Country:US
Mailing Address - Phone:516-253-7634
Mailing Address - Fax:
Practice Address - Street 1:3960 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2837
Practice Address - Country:US
Practice Address - Phone:516-253-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108532104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker