Provider Demographics
NPI:1205847258
Name:BRECK, SHEILA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:BRECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:HALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-751-2113
Mailing Address - Fax:631-444-0084
Practice Address - Street 1:100 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-751-2113
Practice Address - Fax:631-444-0084
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL0471631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical