Provider Demographics
NPI:1225130727
Name:RUANE, SHANNON MARY (MS, CRC, LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARY
Last Name:RUANE
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 HARBOUR DR
Mailing Address - Street 2:APT C1
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7021
Mailing Address - Country:US
Mailing Address - Phone:215-244-0845
Mailing Address - Fax:
Practice Address - Street 1:LAND TITLE BLDG
Practice Address - Street 2:100 S. BROAD STREET, SUITE 1309
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1023
Practice Address - Country:US
Practice Address - Phone:215-244-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018724950001Medicaid