Provider Demographics
NPI:1972719524
Name:WARMING, SHANNON SUSANNE (MFT-INTERN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SUSANNE
Last Name:WARMING
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:SUSANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 JOSE FIGUERES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2022
Mailing Address - Country:US
Mailing Address - Phone:408-347-3134
Mailing Address - Fax:
Practice Address - Street 1:101 JOSE FIGUERES
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-347-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 53422103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling