Provider Demographics
NPI:1619703154
Name:MAROLDO, SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MAROLDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STONEY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1657
Mailing Address - Country:US
Mailing Address - Phone:732-943-6791
Mailing Address - Fax:
Practice Address - Street 1:29 STONEY CREEK LN
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1657
Practice Address - Country:US
Practice Address - Phone:732-943-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC1064300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health