Provider Demographics
NPI:1134489461
Name:SHIELDS-CHURCH, LEIGH ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEIGH ANNE
Middle Name:
Last Name:SHIELDS-CHURCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LEIGH ANNE
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 PARK STREET
Mailing Address - Street 2:RM #206
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7841
Mailing Address - Fax:203-974-7322
Practice Address - Street 1:34 PARK STREET
Practice Address - Street 2:RM #206
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7841
Practice Address - Fax:203-974-7322
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical