Provider Demographics
NPI:1700399532
Name:KERECMAN-SILVESTRI, SHANNON ELISABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELISABETH
Last Name:KERECMAN-SILVESTRI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SPAULDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3945 SAN JOSE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4612
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:
Practice Address - Street 1:3945 SAN JOSE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4612
Practice Address - Country:US
Practice Address - Phone:904-448-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18024101YM0800X
FL16510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health