Healthcare Provider Details

I. General information

NPI: 1912247115
Provider Name (Legal Business Name): SHANNON E MCLAFFERTY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W GROVE ST
CLARKS SUMMIT PA
18411-2090
US

IV. Provider business mailing address

301 W GROVE ST
CLARKS SUMMIT PA
18411-2090
US

V. Phone/Fax

Practice location:
  • Phone: 570-466-9438
  • Fax: 570-587-5224
Mailing address:
  • Phone: 570-466-9438
  • Fax: 570-587-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020395
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: