Healthcare Provider Details

I. General information

NPI: 1073828588
Provider Name (Legal Business Name): SHANNON S. KANE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON BIELAT

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOODY ST
SACO ME
04072-1536
US

IV. Provider business mailing address

50 MOODY ST
SACO ME
04072-1536
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone: 207-636-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14541
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: