Provider Demographics
NPI:1235447343
Name:SHANNAN M CASON PSYD LLC
Entity Type:Organization
Organization Name:SHANNAN M CASON PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-708-3750
Mailing Address - Street 1:2214 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6702
Mailing Address - Country:US
Mailing Address - Phone:954-927-9555
Mailing Address - Fax:954-921-4064
Practice Address - Street 1:2214 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6702
Practice Address - Country:US
Practice Address - Phone:954-927-9555
Practice Address - Fax:954-921-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty