Provider Demographics
NPI:1740076421
Name:FOLEY, SHANNON (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FOLEY
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17A BRADBURY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4911
Mailing Address - Country:US
Mailing Address - Phone:781-738-2378
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD STE 205
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5173
Practice Address - Country:US
Practice Address - Phone:781-202-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10002907103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling