Provider Demographics
NPI:1952041535
Name:THOMPSON SHEARER, DENISE JOSEPHINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:JOSEPHINE
Last Name:THOMPSON SHEARER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:JOSEPHINE
Other - Last Name:THOMPSON-SHEARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1970 MICHIGAN AVE BLDG E
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5723
Mailing Address - Country:US
Mailing Address - Phone:321-587-9500
Mailing Address - Fax:321-735-8007
Practice Address - Street 1:1970 MICHIGAN AVE BLDG E
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-5723
Practice Address - Country:US
Practice Address - Phone:321-587-9500
Practice Address - Fax:321-735-8007
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1618103TS0200X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool