Healthcare Provider Details

I. General information

NPI: 1689373797
Provider Name (Legal Business Name): SHANNON TEAH ST PIERRE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 ELM RD
NEWTON MA
02460-2135
US

IV. Provider business mailing address

PO BOX 600026
NEWTON MA
02460-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-564-1518
  • Fax:
Mailing address:
  • Phone: 617-564-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006250
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: