Provider Demographics
NPI:1669627683
Name:MADDOCKS, SHONA K (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SHONA
Middle Name:K
Last Name:MADDOCKS
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 1:40 BOLIVIA ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2843
Mailing Address - Country:US
Mailing Address - Phone:860-455-8648
Mailing Address - Fax:860-423-5353
Practice Address - Street 1:40 BOLIVIA ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2843
Practice Address - Country:US
Practice Address - Phone:860-455-8648
Practice Address - Fax:860-423-5353
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical