Provider Demographics
NPI:1710697438
Name:COOPER, SHANNON LEIGHANNE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGHANNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PEARL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4866
Mailing Address - Country:US
Mailing Address - Phone:207-557-1033
Mailing Address - Fax:
Practice Address - Street 1:49 OAK ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5118
Practice Address - Country:US
Practice Address - Phone:207-458-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical