MEDICARE: JOSHUA SHAMOON LICSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	T-17-348	OR
2	1041C0700X	Clinical Social Worker	089.0135034	VT

General Provider Information

NPI Number	:	1497241640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA SHAMOON LICSW

Provider Business Mailing Address
First Line	:	132 LOALDO DR
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05408-2419
Country	:	US
Telephone Number	:	802-865-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	486 MAIN ST APT A
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-865-3450
Fax Number	:

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

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	12/28/2022

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Directions to “ JOSHUA SHAMOON LICSW” Practice Location

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