Healthcare Provider Details

I. General information

NPI: 1740076421
Provider Name (Legal Business Name): SHANNON FOLEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CABOT RD STE 205
MEDFORD MA
02155-5173
US

IV. Provider business mailing address

10 CABOT RD STE 205
MEDFORD MA
02155-5173
US

V. Phone/Fax

Practice location:
  • Phone: 781-202-6524
  • Fax:
Mailing address:
  • Phone: 781-551-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10002907
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10002907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: