MEDICARE: SHANNON WATTS LCSW

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	1041C0700X	Clinical Social Worker	LC16979	ME

General Provider Information

NPI Number	:	1881050300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON WATTS LCSW

Provider Business Mailing Address
First Line	:	201 MARINER WAY # 1009
Second Line	:
City	:	BIDDEFORD
State	:	ME
Zip	:	04005-9437
Country	:	US
Telephone Number	:	207-229-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 LYNWOOD DR
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4636
Country	:	US
Telephone Number	:	207-229-6469
Fax Number	:

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

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	08/11/2025

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