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General NPI Number Information
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NPI Number | 1184112948
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Entity Type | Individual
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Provider Name | SHAWN CHANNELL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 76 SUMMER ST STE 115
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City | FITCHBURG
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State | MA
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Zip | 01420-5705
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Country | US
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Telephone | 978-257-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 144 MAIN ST
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City | WESTMINSTER
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State | MA
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Zip | 01473-1542
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Country | US
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Telephone | 978-257-4958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 18566
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 9403
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License Number State | MA
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