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General NPI Number Information
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NPI Number | 1548873755
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Entity Type | Individual
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Provider Name | SHANNON CASEY PSY 31889
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Gender | Female
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 215 W MADISON AVE
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City | EL CAJON
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State | CA
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Zip | 92020-3405
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Country | US
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Telephone | 619-401-6227
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Fax |
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Provider Business Mailing Address
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Address Line | 13924 BARRYMORE ST
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City | SAN DIEGO
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State | CA
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Zip | 92129-3116
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Country | US
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Telephone | 619-248-3030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 31889
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License Number State | CA
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