Provider Demographics
NPI:1043864770
Name:SHAHONEY, KIMBERLY (MS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SHAHONEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 BODNICK ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-1801
Mailing Address - Country:US
Mailing Address - Phone:570-766-0171
Mailing Address - Fax:
Practice Address - Street 1:141 SALEM AVE STE 104
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2574
Practice Address - Country:US
Practice Address - Phone:570-766-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health