Provider Demographics
NPI:1548592512
Name:THUMANN, SHANNON KATHLEEN MARIE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:KATHLEEN MARIE
Last Name:THUMANN
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:KATHLEEN MARIE
Other - Last Name:AMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 MASSACHUSETTS AVE STE M03
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3143
Mailing Address - Country:US
Mailing Address - Phone:617-764-9202
Mailing Address - Fax:
Practice Address - Street 1:929 MASSACHUSETTS AVE STE M03
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3143
Practice Address - Country:US
Practice Address - Phone:617-764-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54521041C0700X
MALICSW11410061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical