1215290853 NPI number — SHANNON MARIE BERNARD ADAMS LMHC

Table of content: THERESA THOMASON (NPI 1952769069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215290853 NPI number — SHANNON MARIE BERNARD ADAMS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNARD ADAMS
Provider First Name:
SHANNON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215290853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 HEMPHILL PLACE
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
MALTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-4423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-289-5072
Provider Business Mailing Address Fax Number:
518-289-5225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 NOTT STREET EAST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NISKAYUNA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-6263
Provider Business Practice Location Address Fax Number:
518-289-5225
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC006393 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 006712-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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