Provider Demographics
NPI:1013583640
Name:SHADE OF LIGHT COUNSELING LLC
Entity Type:Organization
Organization Name:SHADE OF LIGHT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-768-4427
Mailing Address - Street 1:92 BLUEBERRY KNLS
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1716
Mailing Address - Country:US
Mailing Address - Phone:203-768-4427
Mailing Address - Fax:
Practice Address - Street 1:92 BLUEBERRY KNLS
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1716
Practice Address - Country:US
Practice Address - Phone:203-768-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty