=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811388283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELLE SHANNON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2015
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 469 CENTERVILLE RD STE 105
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-773-3700
-----------------------------------------------------
Fax | 401-773-3701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 HARRINGTON RD
-----------------------------------------------------
City | FOSTER
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02825-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-489-8012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CSW01680
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------