Provider Demographics
NPI:1629302922
Name:BISCHOFF, SHANNON I (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:I
Last Name:BISCHOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CAPTAIN BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2924
Mailing Address - Country:US
Mailing Address - Phone:978-635-9655
Mailing Address - Fax:
Practice Address - Street 1:99 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2621
Practice Address - Country:US
Practice Address - Phone:978-458-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20306421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305638Medicaid