Provider Demographics
NPI:1396639563
Name:HUNNEWELL, SHANNON LYN (LSWA, LADC II)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYN
Last Name:HUNNEWELL
Suffix:
Gender:F
Credentials:LSWA, LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3767
Mailing Address - Country:US
Mailing Address - Phone:978-632-0934
Mailing Address - Fax:
Practice Address - Street 1:827 GREEN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1105
Practice Address - Country:US
Practice Address - Phone:978-830-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALSWA4160921041C0700X
MA22120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)