MEDICARE: SHANNON MURPHY CERISE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4300	LA
2	1041C0700X	Clinical Social Worker	61433	TX

General Provider Information

NPI Number	:	1528333937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MURPHY CERISE LCSW

Provider Business Mailing Address
First Line	:	1548 EASTUS DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2511
Country	:	US
Telephone Number	:	225-773-6338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 EASTUS DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2511
Country	:	US
Telephone Number	:	225-773-6338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	01/25/2023

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Directions to “ SHANNON MURPHY CERISE LCSW” Practice Location

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