Provider Demographics
NPI:1285006908
Name:HEANEY, SHANNAN TERESA (MS BCBA)
Entity Type:Individual
Prefix:MS
First Name:SHANNAN
Middle Name:TERESA
Last Name:HEANEY
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MAIN ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3161
Mailing Address - Country:US
Mailing Address - Phone:401-885-0639
Mailing Address - Fax:
Practice Address - Street 1:1050 MAIN ST
Practice Address - Street 2:SUITE 23
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3161
Practice Address - Country:US
Practice Address - Phone:401-885-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst