Provider Demographics
NPI:1053953190
Name:MCCARRICK, SHANNON M (PHD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:MCCARRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 E CHERYL PKWY # W323
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7700
Mailing Address - Country:US
Mailing Address - Phone:412-657-0150
Mailing Address - Fax:
Practice Address - Street 1:5131 E CHERYL PKWY # W323
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7700
Practice Address - Country:US
Practice Address - Phone:412-657-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3725103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist