Provider Demographics
NPI:1700366762
Name:PERSCHY, SHANNON HALL (LICSW, CCM)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:HALL
Last Name:PERSCHY
Suffix:
Gender:F
Credentials:LICSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-3209
Mailing Address - Country:US
Mailing Address - Phone:508-242-5333
Mailing Address - Fax:
Practice Address - Street 1:6 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-3209
Practice Address - Country:US
Practice Address - Phone:508-242-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10322731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical