Provider Demographics
NPI:1407880990
Name:MCCASLIN-RODRIGO, SHANNON ELISE (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELISE
Last Name:MCCASLIN-RODRIGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELISE
Other - Last Name:MCCASLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:SF VA MEDICAL CENTER, 4150 CLEMENT ST. (116P)
Mailing Address - Street 2:PTSD RESEARCH PROGRAM, BLDG 8, ROOM 320
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-751-2297
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:SFVAMC, PTSD RESEARCH PROGRAM (116P), BLDG 8, ROOM 320
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-751-2297
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical