Provider Demographics
NPI:1972647592
Name:STANHOPE, SHANNON (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:STANHOPE
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 1:2 SPRINGBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-1500
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:2 SPRINGBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-282-1500
Practice Address - Fax:207-282-7509
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10985104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431685799Medicaid