Provider Demographics
NPI:1124578158
Name:SEELEY, SHANNON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:SEELEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SOQUEL DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2861
Mailing Address - Country:US
Mailing Address - Phone:831-219-3156
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR STE 600
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2861
Practice Address - Country:US
Practice Address - Phone:831-219-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS234611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical