Healthcare Provider Details

I. General information

NPI: 1861326209
Provider Name (Legal Business Name): SHANNON NICOLE PHILPOTT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BENNETT RD UNIT 414
ENGLEWOOD NJ
07631-3271
US

IV. Provider business mailing address

175 E MAIN ST
BERGENFIELD NJ
07621-2236
US

V. Phone/Fax

Practice location:
  • Phone: 201-421-1791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06697300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: