Provider Demographics
NPI:1629550066
Name:BOSWORTH, SHANNON FARREN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:FARREN
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077
Mailing Address - Country:US
Mailing Address - Phone:603-244-1256
Mailing Address - Fax:
Practice Address - Street 1:15 GREEN RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077
Practice Address - Country:US
Practice Address - Phone:603-244-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health