Provider Demographics
NPI:1316444052
Name:MISSNER, SHANI COHEN (MD, PHD, LCSW-C, CLC)
Entity type:Individual
Prefix:DR
First Name:SHANI
Middle Name:COHEN
Last Name:MISSNER
Suffix:
Gender:F
Credentials:MD, PHD, LCSW-C, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 DARNESTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2604
Mailing Address - Country:US
Mailing Address - Phone:240-630-4497
Mailing Address - Fax:301-279-2232
Practice Address - Street 1:10810 DARNESTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2604
Practice Address - Country:US
Practice Address - Phone:240-630-4497
Practice Address - Fax:301-279-2232
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2024-07-01
Deactivation Date:2018-08-21
Deactivation Code:
Reactivation Date:2024-06-13
Provider Licenses
StateLicense IDTaxonomies
MD278491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical