Provider Demographics
NPI:1487921730
Name:SHEA, KERRYANNE (LMFT)
Entity type:Individual
Prefix:
First Name:KERRYANNE
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 DELANEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1326
Mailing Address - Country:US
Mailing Address - Phone:352-315-7100
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:201 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3583
Practice Address - Country:US
Practice Address - Phone:352-315-7100
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1876103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily