Provider Demographics
NPI:1447393459
Name:HERR, SHANNON MARIE (LMHC CASAC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE
Last Name:HERR
Suffix:
Gender:F
Credentials:LMHC CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 E QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2547
Mailing Address - Country:US
Mailing Address - Phone:716-536-6950
Mailing Address - Fax:716-992-2683
Practice Address - Street 1:6666 E QUAKER ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2547
Practice Address - Country:US
Practice Address - Phone:716-536-6950
Practice Address - Fax:716-992-2683
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17605OtherCASAC
NY002613OtherMENTAL HEALTH COUNSELOR