Healthcare Provider Details

I. General information

NPI: 1689925430
Provider Name (Legal Business Name): SHANNON M JOSEPH LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4759 RESERVOIR RD NW
WASHINGTON DC
20007-1921
US

IV. Provider business mailing address

4759 RESERVOIR RD NW
WASHINGTON DC
20007-1921
US

V. Phone/Fax

Practice location:
  • Phone: 202-965-6600
  • Fax:
Mailing address:
  • Phone: 202-965-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004741
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020058
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: