Provider Demographics
NPI:1548788250
Name:COMEAUX, SHANDA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:NICOLE
Last Name:COMEAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:NICOLE
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11 MIDDLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5710
Mailing Address - Country:US
Mailing Address - Phone:860-805-3381
Mailing Address - Fax:
Practice Address - Street 1:357 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4472
Practice Address - Country:US
Practice Address - Phone:860-200-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0099091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical