Provider Demographics
NPI:1316014921
Name:SHAMI, WENDY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:SHAMI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0825
Mailing Address - Country:US
Mailing Address - Phone:860-672-6851
Mailing Address - Fax:
Practice Address - Street 1:384 CREAM HILL RD
Practice Address - Street 2:
Practice Address - City:WEST CORNWALL
Practice Address - State:CT
Practice Address - Zip Code:06796-1208
Practice Address - Country:US
Practice Address - Phone:860-672-6851
Practice Address - Fax:860-672-2923
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical