Healthcare Provider Details

I. General information

NPI: 1306538475
Provider Name (Legal Business Name): SHANNON MARIE CAHILL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MARIE CAHILL LPC

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOPE RD STE 3B
EATONTOWN NJ
07724-1273
US

IV. Provider business mailing address

28 LOCUST AVE
EATONTOWN NJ
07724-1609
US

V. Phone/Fax

Practice location:
  • Phone: 732-724-1234
  • Fax:
Mailing address:
  • Phone: 917-789-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01195800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00697200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: