Provider Demographics
NPI:1205543535
Name:SHANNON CANTILLANO LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:SHANNON CANTILLANO LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTILLANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-460-7300
Mailing Address - Street 1:7343 EL CAMINO REAL # 226
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4697
Mailing Address - Country:US
Mailing Address - Phone:805-460-7300
Mailing Address - Fax:805-468-4290
Practice Address - Street 1:9700 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5579
Practice Address - Country:US
Practice Address - Phone:805-460-7300
Practice Address - Fax:805-468-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty