Provider Demographics
NPI:1891379467
Name:KILROY, SHANNON MARIE (MS, LPC, LPCMH, NCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:KILROY
Suffix:
Gender:F
Credentials:MS, LPC, LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E COOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1404
Mailing Address - Country:US
Mailing Address - Phone:267-235-8555
Mailing Address - Fax:
Practice Address - Street 1:112 W OAK LN
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1346
Practice Address - Country:US
Practice Address - Phone:267-854-7715
Practice Address - Fax:267-481-7172
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00838300101YM0800X
DEPC-0011101101YM0800X
PAPC013263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health