Jennifer Louise Shannon, MSW, LICSW

Individual provider Active NPI Mental Health Counselor · Provincetown, MA

NPI 1528050812 · NPPES record last updated Jul 13, 2026

Key facts

NPI: 1528050812
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
License: 107036 (MA)
Practice address: 30 Conwell St
#1
Provincetown, MA 02657-1548
Phone: (508) 487-1192
Fax: (508) 487-5813
NPI assigned: Aug 22, 2005
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Gosnold, Inc. Children's Substance Abuse Rehabilitation Facility · Falmouth, MA · NPI 1639219314

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
107036	MA	MD	Mental Health Counselor

Practice roles

Organization	Specialty	Status	New patients
Gosnold, Inc.		Past since Aug 6, 2015	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	107036	MA	Yes

Addresses

Primary practice location

30 Conwell St
#1
Provincetown, MA 02657-1548

Mailing address

PO Box 2014
Truro, MA 02666-2014
Phone (508) 487-1192

Other providers in Provincetown, MA

All providers in Provincetown, 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 Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.