Provider Demographics
NPI:1457180697
Name:FLAHERTY GIBBONS, SHANNON VALEEN (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:VALEEN
Last Name:FLAHERTY GIBBONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N DEERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4580
Mailing Address - Country:US
Mailing Address - Phone:714-308-9323
Mailing Address - Fax:
Practice Address - Street 1:137 N DEERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4580
Practice Address - Country:US
Practice Address - Phone:714-308-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical