Provider Demographics
NPI:1851583843
Name:GAMACHE, SHANNON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MACKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3636 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1927
Mailing Address - Country:US
Mailing Address - Phone:480-848-9831
Mailing Address - Fax:602-241-5756
Practice Address - Street 1:3636 N CENTRAL AVE # A104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1927
Practice Address - Country:US
Practice Address - Phone:808-489-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-182471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical