Provider Demographics
NPI:1760419287
Name:ANGELOTTI, SHANNON (LICSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ANGELOTTI
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 1:181 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:N SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2120
Mailing Address - Country:US
Mailing Address - Phone:401-374-0225
Mailing Address - Fax:
Practice Address - Street 1:181 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:N SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-2120
Practice Address - Country:US
Practice Address - Phone:401-374-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017291041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical