Provider Demographics
NPI:1134296403
Name:COONERTY, SHEILA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:M
Last Name:COONERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DIMOND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3423
Mailing Address - Country:US
Mailing Address - Phone:831-429-4115
Mailing Address - Fax:831-600-7528
Practice Address - Street 1:119 DIMOND ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3423
Practice Address - Country:US
Practice Address - Phone:831-429-4115
Practice Address - Fax:831-600-7528
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist