Provider Demographics
NPI:1679115224
Name:HONCE, SHANNON SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:SUE
Last Name:HONCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:SUE
Other - Last Name:SPEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2 CASSIE PL
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2471
Mailing Address - Country:US
Mailing Address - Phone:631-220-0198
Mailing Address - Fax:
Practice Address - Street 1:350B MARTHA AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1525
Practice Address - Country:US
Practice Address - Phone:631-286-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker