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NPI Code Detail

MEDICARE: SHANNON ROY MS

MEDICARE: SHANNON ROY MS
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1528187366
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ROY MS
Provider Business Mailing Address
First Line : 13 PATRICK RD
Second Line :
City : TEWKSBURY
State : MA
Zip : 01876-4701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 116 SUMMER ST
Second Line :
City : HAVERHILL
State : MA
Zip : 01830-6032
Country : US
Telephone Number : 781-871-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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