Healthcare Provider Details

I. General information

NPI: 1588541106
Provider Name (Legal Business Name): SHANNON MARIE FISHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON MARIE RAVERT

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 WHITE DEER PIKE
NEW COLUMBIA PA
17856-9244
US

IV. Provider business mailing address

1465 WHITE DEER PIKE
NEW COLUMBIA PA
17856-9244
US

V. Phone/Fax

Practice location:
  • Phone: 570-204-2337
  • Fax:
Mailing address:
  • Phone: 570-204-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCW023133
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: