Doctor Name: | THERESA SARLUCA SHANNON |
NPI Number: | 1366532335 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | R058454-1 |
Business Practice Address: | 445 Oak St Copiague, NY - 117263111 |
Business Phone Number: | 6316913347 |
Business Fax Number: | 6316913728 |
Mailing Address: | 7 Redlef St, EAST PATCHOGUE |
State: | NY |
Postal Code: | 117724596 |
Phone Number: | 6317586353 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R058454-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |