Healthcare Provider Details

I. General information

NPI: 1225130727
Provider Name (Legal Business Name): SHANNON MARY RUANE M.S., CRC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAND TITLE BLDG 100 S. BROAD STREET, SUITE 1309
PHILADELPHIA PA
19110-1023
US

IV. Provider business mailing address

522 HARBOUR DR APT C1
BENSALEM PA
19020-7021
US

V. Phone/Fax

Practice location:
  • Phone: 215-244-0845
  • Fax:
Mailing address:
  • Phone: 215-244-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003801
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: