Provider Demographics
NPI:1205932878
Name:CAGGIANO, SHIRLEY JEAN (LCSW/PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JEAN
Last Name:CAGGIANO
Suffix:
Gender:F
Credentials:LCSW/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2561 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2417
Mailing Address - Country:US
Mailing Address - Phone:656-376-8894
Mailing Address - Fax:636-789-5815
Practice Address - Street 1:10626 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5039
Practice Address - Country:US
Practice Address - Phone:636-789-2747
Practice Address - Fax:636-789-5815
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13308Medicare UPIN
MOR22158Medicare UPIN