Provider Demographics
NPI:1780237479
Name:CRONICAN, SHANA MARIE (LISW)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:CRONICAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 PATTERSON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3869
Mailing Address - Country:US
Mailing Address - Phone:513-236-2631
Mailing Address - Fax:
Practice Address - Street 1:778 OLD STATE ROUTE 74
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1213
Practice Address - Country:US
Practice Address - Phone:513-236-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist