Healthcare Provider Details

I. General information

NPI: 1972719524
Provider Name (Legal Business Name): SHANNON SUSANNE WARMING MFT-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SHANNON SUSANNE TAYLOR

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JOSE FIGUERES
SAN JOSE CA
95116
US

IV. Provider business mailing address

101 JOSE FIGUERES AVE
SAN JOSE CA
95116-2022
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-3134
  • Fax:
Mailing address:
  • Phone: 408-347-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberIMF 53422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: