Provider Demographics
NPI:1720035041
Name:AYOTTE STAUFFER, SHANNON LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:AYOTTE STAUFFER
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 1:720 HOPMEADOW ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2224
Mailing Address - Country:US
Mailing Address - Phone:860-651-3489
Mailing Address - Fax:860-623-1123
Practice Address - Street 1:720 HOPMEADOW ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2224
Practice Address - Country:US
Practice Address - Phone:860-651-3489
Practice Address - Fax:860-623-1123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical