SHANNON LEE SMALL (NPI# 1487159075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487159075 |
| Entity Type | Individual |
| Full Name | SHANNON LEE SMALL |
| Credential | CADC |
| Practice Address |
248 State St Ste 13b Ellsworth ME 04605-1850 |
| Practice Telephone | 2078355809 |
| Mailing Telephone | 2078355809 |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-03-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CAC4944 | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730312356 | Shannon Natsuko Small | Occupational Therapist | 50 Dekalb Ave, S2, White Plains, NY 10605-1445 | 2009-08-30 |
| 1932360161 | Shannon F. Small | Surgery | 800 E Carpenter St, Springfield, IL 62702-5324 | 2008-06-20 |
| Street Address |
248 STATE ST STE 13B |
| City | ELLSWORTH |
| State | ME |
| Zip Code | 04605-1850 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932602745 | Susan Polyot | Counselor | 248 State St Ste 13b, Ellsworth, ME 04605-1850 | 2018-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760940464 | Mary Elizabeth Wagstaff | Occupational Therapist | Seaport Village Healthcare, 19 General Moore Way, Ellsworth, ME 04605 | 2019-03-12 |
| 1154784668 | Black Dog Medical Pa | Internal Medicine | 11 Madison Avenue, Lamoine, ME 04605 | 2016-04-01 |
| 1528466687 | Eyecare Now | Point of Service | 248 State St., Ste. 7, Ellsworth, ME 04605 | 2014-12-05 |
| 1104245364 | Elizabeth Arntzen | Massage Therapist | 61 Pine St., Ellsworth, ME 04605 | 2014-04-15 |
| 1992144794 | Kenneth L Senter | Family Medicine | 248 State St., Ellsworth Free Medical Clinic, Ellsworth, ME 04605 | 2013-06-14 |
| 1639465248 | Lynne Marie Betz | Dental Hygienist | 52 Christian Ridge Road, Ellsworth, ME 04605 | 2011-06-22 |
| 1215238431 | Kimberly Ann Burgess | Social Worker | 23 Carriage Way, Ellsworth, ME 04605 | 2010-11-04 |
| 1962713115 | Springy Pond Farm | Voluntary or Charitable | 562 Springy Pond Rd., Otis, ME 04605 | 2010-06-23 |
| 1851629851 | Astor Charlene Gillis | Counselor | 59 Franklin St., Suite B, Ellsworth, ME 04605 | 2009-12-02 |
| 1326372723 | Patricia Brown Orchard | Community Health Worker | 10 Water Street, Suite 124, Ellsworth, ME 04605 | 2009-10-01 |
| Find all providers in zip 04605 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962972695 | Richard Allen Moldenhauer | Counselor | W8972 520th Ave, Ellsworth, WI 54011-4887 | 2018-11-26 |
| 1912481052 | Amanda Lee Day | Counselor | Open Door Recovery Center, 8 Old Mill Road, Ellsworth, ME 04605-0958 | 2018-09-24 |
| 1932602745 | Susan Polyot | Counselor | 248 State St Ste 13b, Ellsworth, ME 04605-1850 | 2018-03-18 |
| 1851629851 | Astor Charlene Gillis | Counselor | 59 Franklin St., Suite B, Ellsworth, ME 04605 | 2009-12-02 |
| 1659606168 | Steven E. Steinhaus | Counselor | 525 E 3rd St, Ellsworth, KS 67439-3618 | 2009-10-16 |
| 1164586236 | Gina Marie Veits | Counselor | 8 Old Mill Rd, Ellsworth, ME 04605-0958 | 2006-12-21 |
| 1902407315 | Sally Brann | Counselor | 70 Kingsland Xing Ste A, Ellsworth, ME 04605-2570 | 2020-11-03 |
| 1154956043 | Joan Piskura | Counselor | 70 Kingsland Xing Ste A, Ellsworth, ME 04605-2570 | 2020-03-11 |
| 1013319375 | Steinhaus Counseling, LLC | Counselor | 525 E 3rd St, Ellsworth, KS 67439-3618 | 2014-09-18 |
| 1235538687 | Richard K Horton | Counselor | 8 Old Mill Road, Ellsworth, ME 04605-0958 | 2014-08-21 |
| Find all providers in ELLSWORTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.