Provider Demographics
NPI:1124211628
Name:QUEIROGA, SHANNON ELAINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELAINE
Last Name:QUEIROGA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MONROE ST
Mailing Address - Street 2:APT. D
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-5725
Mailing Address - Country:US
Mailing Address - Phone:203-415-5321
Mailing Address - Fax:
Practice Address - Street 1:137 EAST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5702
Practice Address - Country:US
Practice Address - Phone:203-415-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional