Provider Demographics
NPI:1902323835
Name:PAISLEY, SHANNON (LCAT, ATRBC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:PAISLEY
Suffix:
Gender:F
Credentials:LCAT, ATRBC
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3795
Mailing Address - Country:US
Mailing Address - Phone:1914-572-3015
Mailing Address - Fax:
Practice Address - Street 1:328 MAIN ST. #1
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:1914-572-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor