Provider Demographics
NPI:1134808579
Name:DIMAGGIO, SHANENA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:SHANENA
Middle Name:MARIE
Last Name:DIMAGGIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 RANSOM RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2330
Mailing Address - Country:US
Mailing Address - Phone:716-777-1720
Mailing Address - Fax:
Practice Address - Street 1:4130 RANSOM RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2330
Practice Address - Country:US
Practice Address - Phone:716-777-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008411-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health