Healthcare Provider Details

I. General information

NPI: 1811944952
Provider Name (Legal Business Name): KARLOTTA SHANAHAN LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 WASHINGTON RD
RYE NH
03870-2346
US

IV. Provider business mailing address

PO BOX 95
RYE BEACH NH
03871-0095
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-3191
  • Fax:
Mailing address:
  • Phone: 603-964-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number349
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: