Provider Demographics
NPI:1114163631
Name:LETO, SHIRLEY A
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:A
Last Name:LETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHARON CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-3007
Mailing Address - Country:US
Mailing Address - Phone:203-913-7733
Mailing Address - Fax:
Practice Address - Street 1:11 SHARON CT
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-3007
Practice Address - Country:US
Practice Address - Phone:203-913-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1114163631Medicaid
CT004039244Medicaid