Provider Demographics
NPI:1881050300
Name:WATTS, SHANNON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WATTS
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 1:201 MARINER WAY # 1009
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9437
Mailing Address - Country:US
Mailing Address - Phone:207-229-6469
Mailing Address - Fax:
Practice Address - Street 1:35 LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04061-4636
Practice Address - Country:US
Practice Address - Phone:207-229-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC169791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical