Provider Demographics
NPI:1164400016
Name:SHEA, SHARON ELIZABETH (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3057
Mailing Address - Country:US
Mailing Address - Phone:203-744-9737
Mailing Address - Fax:203-529-0581
Practice Address - Street 1:6 PARTRIDGE LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3057
Practice Address - Country:US
Practice Address - Phone:203-744-9737
Practice Address - Fax:203-529-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT291101YA0400X
CT39911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT111518Medicare UPIN
CT140003991CT01Medicare UPIN
CTP938726Medicare UPIN
CT181071Medicare UPIN
CT2001323Medicare UPIN