MEDICARE: SHANNON R SOKOLOWSKI 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	1041C0700X	Clinical Social Worker	112263	MA
2	1041C0700X	Clinical Social Worker	2785	NH

General Provider Information

NPI Number	:	1932131620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON R SOKOLOWSKI LICSW

Provider Business Mailing Address
First Line	:	PO BOX 183
Second Line	:
City	:	SULLIVAN
State	:	NH
Zip	:	03445-0183
Country	:	US
Telephone Number	:	774-260-1158
Fax Number	:	508-433-1871

Provider Business Practice Location Address
First Line	:	172 VALLEY RD
Second Line	:
City	:	SULLIVAN
State	:	NH
Zip	:	03445-4233
Country	:	US
Telephone Number	:	774-260-1158
Fax Number	:	508-433-1871

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/02/2024

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