Provider Demographics
NPI:1689948887
Name:FANELLI, SHARI FAYE (MS, LPC, ATR)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:FAYE
Last Name:FANELLI
Suffix:
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 SYLVAN KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5355
Mailing Address - Country:US
Mailing Address - Phone:201-446-8677
Mailing Address - Fax:
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3713
Practice Address - Country:US
Practice Address - Phone:203-517-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional