Provider Demographics
NPI:1811646029
Name:WOFFORD, SHANNON E (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:E
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:913 LOCK ST
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1041
Mailing Address - Country:US
Mailing Address - Phone:412-728-0252
Mailing Address - Fax:
Practice Address - Street 1:913 LOCK ST
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1041
Practice Address - Country:US
Practice Address - Phone:412-728-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0247781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical