Healthcare Provider Details

I. General information

NPI: 1649962770
Provider Name (Legal Business Name): SHANNON PRINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

469 CENTERVILLE RD STE 105
WARWICK RI
02886-4356
US

IV. Provider business mailing address

469 CENTERVILLE RD STE 105
WARWICK RI
02886-4356
US

V. Phone/Fax

Practice location:
  • Phone: 401-773-3700
  • Fax: 401-773-3701
Mailing address:
  • Phone: 401-773-3700
  • Fax: 401-773-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: