Provider Demographics
NPI:1083815153
Name:SHANAHAN, DELMA G
Entity Type:Individual
Prefix:MS
First Name:DELMA
Middle Name:G
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 RHODA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3322
Mailing Address - Country:US
Mailing Address - Phone:510-336-2769
Mailing Address - Fax:
Practice Address - Street 1:3801 RHODA AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3322
Practice Address - Country:US
Practice Address - Phone:510-336-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor