Shannon E Pettit, LCSW, CADC, CCS is a medicare enrolled "Social Worker - Clinical" provider in Bangor, Maine. Her current practice location is
68 Mount Hope Ave, Bangor, Maine. You can reach out to her office (for appointments etc.) via phone at
(207) 949-3270.
Shannon E Pettit is licensed to practice in Maine (license number LC13000) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1649474156.
Healthcare Provider's Profile
| Full Name | Shannon E Pettit |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 68 Mount Hope Ave, Bangor, Maine |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1649474156
- Provider Enumeration Date: 06/11/2007
- Last Update Date: 12/07/2025
Medicare PECOS Information:
- PECOS PAC ID: 6800151622
- Enrollment ID: I20180529001841
Medical Identifiers
Medical identifiers for Shannon E Pettit such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1649474156 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CAC4201 (Maine) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CCS8417 (Maine) | Secondary |
| 1041C0700X | Social Worker - Clinical | LC13000 (Maine) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shannon E Pettit allows following entities to bill medicare on her behalf.
| Entity Name | Cornerstone Behavioral Healthcare Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215102850
PECOS PAC ID: 7214097740
Enrollment ID: O20081113000616 |
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| Entity Name | Dirigo Counseling Clinic, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295734085
PECOS PAC ID: 3375767023
Enrollment ID: O20140619000334 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shannon E Pettit is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shannon E Pettit, LCSW, CADC, CCS
57 Penobscot Ave,
Millinocket, ME 04462-1320
Ph: (207) 949-3270 | Shannon E Pettit, LCSW, CADC, CCS
68 Mount Hope Ave,
Bangor, ME 04401-4096
Ph: (207) 949-3270 |
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