Provider Demographics
NPI:1669233326
Name:MCDOLE, SHANNON YVETTE (LMSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:YVETTE
Last Name:MCDOLE
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 1:26 COUNTRY KNLS
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5001
Mailing Address - Country:US
Mailing Address - Phone:845-235-6801
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-235-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083085-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty