Provider Demographics
NPI:1760939789
Name:COLE, SHANNON (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2137
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:716-363-6851
Practice Address - Street 1:319 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2137
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:716-363-6851
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098543-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760747521OtherHRSA GRANT