Provider Demographics
NPI:1780811364
Name:CANTILLANO, SHANNON JOANN (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:JOANN
Last Name:CANTILLANO
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 1:7343 EL CAMINO REAL STE 226
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4697
Mailing Address - Country:US
Mailing Address - Phone:805-471-6545
Mailing Address - Fax:805-468-4290
Practice Address - Street 1:793 HIGUERA ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3571
Practice Address - Country:US
Practice Address - Phone:805-471-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical