Provider Demographics
NPI:1891436473
Name:ROCKER, SHANNON S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:S
Last Name:ROCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 KATHLEEN TER
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1252
Mailing Address - Country:US
Mailing Address - Phone:315-491-2393
Mailing Address - Fax:
Practice Address - Street 1:102 KATHLEEN TER
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1252
Practice Address - Country:US
Practice Address - Phone:315-491-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical