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General NPI Number Information
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NPI Number | 1942557707
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Entity Type | Organization
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Legal Business Name | SHANNON'S SOCIAL WORK SERVICES, LLC
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Dates
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Enumeration Date | 08/12/2012
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Last Update Date | 08/12/2012
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Provider Practice Location Address
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Address Line | 9395 LAKE SERENA DR
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City | BOCA RATON
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State | FL
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Zip | 33496-6509
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Country | US
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Telephone | 954-296-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 9395 LAKE SERENA DR
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City | BOCA RATON
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State | FL
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Zip | 33496-6509
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Country | US
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Telephone | 954-296-4120
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANNON L THILL
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Credential | LCSW
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Telephone | 954-296-4120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW9726
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License Number State | FL
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