Healthcare Provider Details

I. General information

NPI: 1780811364
Provider Name (Legal Business Name): SHANNON JOANN CANTILLANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 EL CAMINO REAL STE 200
ATASCADERO CA
93422-5579
US

IV. Provider business mailing address

7343 EL CAMINO REAL STE 226
ATASCADERO CA
93422-4697
US

V. Phone/Fax

Practice location:
  • Phone: 805-471-6545
  • Fax: 805-468-4290
Mailing address:
  • Phone: 805-471-6545
  • Fax: 805-468-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: