Provider Demographics
NPI:1619962008
Name:LIMERICK-GNAS, SHANNON (MA LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:LIMERICK-GNAS
Suffix:
Gender:F
Credentials:MA LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2301
Mailing Address - Country:US
Mailing Address - Phone:724-775-9150
Mailing Address - Fax:724-775-9153
Practice Address - Street 1:219 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2301
Practice Address - Country:US
Practice Address - Phone:724-775-9150
Practice Address - Fax:724-775-9153
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006277L103T00000X
103TC1900X, 103TC2200X, 103TB0200X, 103TF0000X, 103TA0700X
PAPS006277-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical