Provider Demographics
NPI:1730386566
Name:SORENSEN, SHANNON LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3578
Mailing Address - Country:US
Mailing Address - Phone:508-612-3073
Mailing Address - Fax:
Practice Address - Street 1:16 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3578
Practice Address - Country:US
Practice Address - Phone:508-612-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical