Shannon J Davidenko, LMHC
Individual provider Active NPI Mental Health Counselor · Northborough, MA
NPI 1386892271 · NPPES record last updated Dec 17, 2018
Key facts
- NPI
- 1386892271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 8189 (MA)
- Practice address
- 44 Bearfoot Rd Ste 300
Northborough, MA 01532-1559 - Phone
- (781) 551-0999
- Fax
- (781) 551-3396
- NPI assigned
- Sep 4, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2008
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251125004099 | MA | Practitioner - Mental Health Counselor | 2365934452 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8189 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Mental Health | Current |
Accepting new patients |
| Child and Family Psychological Services, PLLC | Mental Health | Past |
Accepting new patients |
Locations
100 Cambridge St
Fl 14
Boston, MA 02114
Phone (617) 917-2389
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8189 | MA | Yes |
Addresses
Primary practice location
44 Bearfoot Rd Ste 300
Northborough, MA 01532-1559
Mailing address
89 Access Rd Ste 24
Norwood, MA 02062-5233
Phone (781) 551-0999
Other names
- Ms. Shannon J Lecompte
Other providers in Northborough, MA
- Cynthia M Poulos MD LLC
- Taylor Ann D'Amico
- Meredith M Daelhousen
- Amanda Theresa Dafoe
- David S Wald DMD
- Alicia Wells Day
- Cynthia De Sousa
- Albert Wallace Deckel
- Islam Mohammad Dehis
- Olivia Marie Demers
All providers in Northborough, MA · Mental Health Counselor in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.