Healthcare Provider Details

I. General information

NPI: 1619962008
Provider Name (Legal Business Name): SHANNON LIMERICK-GNAS MA LIC PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 3RD ST
BEAVER PA
15009-2301
US

IV. Provider business mailing address

219 3RD ST
BEAVER PA
15009-2301
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-9150
  • Fax: 724-775-9153
Mailing address:
  • Phone: 724-775-9150
  • Fax: 724-775-9153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006277L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS006277-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: