MEDICARE: KATE SHAUGHNESSY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1730672981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE SHAUGHNESSY

Provider Business Mailing Address
First Line	:	125 N WILKES BARRE BLVD STE 4
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-5354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 N WILKES BARRE BLVD STE 4
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-5354
Country	:	US
Telephone Number	:	570-208-4858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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Directions to “ KATE SHAUGHNESSY ” Practice Location

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