MEDICARE: MS. SHANNON DOYLE LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174292585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON DOYLE LCSW-C

Provider Business Mailing Address
First Line	:	12 DRAWBRIDGE CT
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-2401
Country	:	US
Telephone Number	:	443-204-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	8840 STANFORD BLVD STE 1600
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5909
Country	:	US
Telephone Number	:	240-512-0141
Fax Number	:	240-512-0151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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