Provider Demographics
NPI:1801806906
Name:SHAUGHNESSY, EILEEN (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-255 EL PASEO
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-341-8878
Mailing Address - Fax:760-341-8820
Practice Address - Street 1:73-255 EL PASEO
Practice Address - Street 2:SUITE 6
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-341-8878
Practice Address - Fax:760-341-8820
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 141041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ28139ZMedicare PIN