Provider Demographics
NPI:1528333937
Name:CERISE, SHANNON MURPHY (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MURPHY
Last Name:CERISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 EASTUS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2511
Mailing Address - Country:US
Mailing Address - Phone:225-773-6338
Mailing Address - Fax:
Practice Address - Street 1:1548 EASTUS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2511
Practice Address - Country:US
Practice Address - Phone:225-773-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43001041C0700X
TX614331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical