Provider Demographics
NPI:1437297975
Name:SHOENBERGER, BEVERLY (LPC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SHOENBERGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 KIMBERLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1626
Mailing Address - Country:US
Mailing Address - Phone:860-667-8324
Mailing Address - Fax:
Practice Address - Street 1:221 KIMBERLEY RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1626
Practice Address - Country:US
Practice Address - Phone:860-665-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT240000598CT01OtherANTHEM BCBS