Individual
SHANNON JEAN CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CAS, NCSP, BCBA,
Contact information
Practice address
6 N MAIN ST STE 110, FAIRPORT, NY 14450-1581
(818) 345-2345
Mailing address
23 PENNICOTT CIR, PENFIELD, NY 14526-9541
(585) 303-7329
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-18884
NY
103K00000X
Behavior Analyst
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
03/27/2013
Last updated
06/21/2020
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