Provider Demographics
NPI:1265076327
Name:LANE, SHANNON MONA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MONA
Last Name:LANE
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:S.MHARRIS2007@GMAIL.COM
Mailing Address - Street 2:609 PEACE CHANCE DR.
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078
Mailing Address - Country:US
Mailing Address - Phone:410-982-2846
Mailing Address - Fax:
Practice Address - Street 1:S.MHARRIS2007@GMAIL.COM
Practice Address - Street 2:609 PEACE CHANCE DR.
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:410-982-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker