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General NPI Number Information
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NPI Number | 1427743863
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Entity Type | Individual
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Provider Name | SHANNON CULLIGAN
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 363 MASSACHUSETTS AVE STE 202
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City | LEXINGTON
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State | MA
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Zip | 02420-4018
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Country | US
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Telephone | 860-368-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 3 BOULEVARD ST STE 1R
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City | MILTON
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State | MA
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Zip | 02186-5400
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1306430871
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License Number State | MA
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