Provider Demographics
NPI:1932664406
Name:SCOTT, SHANNON (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SCOTT
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 1:33 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1362
Mailing Address - Country:US
Mailing Address - Phone:914-751-9873
Mailing Address - Fax:
Practice Address - Street 1:33 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1362
Practice Address - Country:US
Practice Address - Phone:914-751-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102580-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker