Healthcare Provider Details

I. General information

NPI: 1225963051
Provider Name (Legal Business Name): SHANNON NICOLETTE SEMINARIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KAISER STRASSE
BEACH LAKE PA
18405-3118
US

IV. Provider business mailing address

8 KAISER STRASSE
BEACH LAKE PA
18405-3118
US

V. Phone/Fax

Practice location:
  • Phone: 862-432-8195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: