Provider Demographics
NPI:1386203636
Name:IANNIELLO, SHAINA MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:MICHELE
Last Name:IANNIELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:MICHELE
Other - Last Name:LEVINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:210 CARRIAGE CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5862
Mailing Address - Country:US
Mailing Address - Phone:203-980-5353
Mailing Address - Fax:
Practice Address - Street 1:210 CARRIAGE CROSSING LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5862
Practice Address - Country:US
Practice Address - Phone:203-980-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0136071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical