Provider Demographics
NPI:1952963233
Name:MCGINNIS, SHANNON MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARY
Last Name:MCGINNIS
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 1:35 OLD TAVERN RD
Mailing Address - Street 2:UNIT 120
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3450
Mailing Address - Country:US
Mailing Address - Phone:203-808-7628
Mailing Address - Fax:
Practice Address - Street 1:370 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3534
Practice Address - Country:US
Practice Address - Phone:203-553-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty