=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477402022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON HARNESS MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 LAKESIDE AVE STE 260
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-5911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-657-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 KNEELAND FLTS
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05676-9767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-721-9931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------