Provider Demographics
NPI:1669524591
Name:FOSTER, SHANNON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGHTOP RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-4112
Mailing Address - Country:US
Mailing Address - Phone:973-409-4368
Mailing Address - Fax:973-208-3344
Practice Address - Street 1:179 CAHILL CROSS RD
Practice Address - Street 2:SUITE 212
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1988
Practice Address - Country:US
Practice Address - Phone:973-248-5896
Practice Address - Fax:973-208-3344
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052459001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3613030OtherOXFORD HEALTH PLANS
NJ094085Medicare ID - Type Unspecified