Individual
REGINA SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 VETERANS MEMORIAL PKWY, RIVERSIDE, RI 02915
(401) 432-1000
(401) 432-1500
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4513
(401) 724-8400
(401) 722-5280
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CSW1778
RI
1041C0700X
Clinical Social Worker
Primary
ISW02919
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GH57134
—
RI
Enumeration date
01/13/2015
Last updated
03/29/2019
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