Healthcare Provider Details

I. General information

NPI: 1578137360
Provider Name (Legal Business Name): SHANNON BOIVIN, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 E CENTER ST
MANCHESTER CT
06040-5205
US

IV. Provider business mailing address

PO BOX 858
WILLIMANTIC CT
06226-0858
US

V. Phone/Fax

Practice location:
  • Phone: 860-327-5850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BOIVIN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 860-327-5850