Provider Demographics
NPI:1922331917
Name:SHEA, MAUREEN F (LPC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:F
Last Name:SHEA
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 1:867 PEQUOT AVE.
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4243
Mailing Address - Country:US
Mailing Address - Phone:860-442-1133
Mailing Address - Fax:860-442-1133
Practice Address - Street 1:867 PEQUOT AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4243
Practice Address - Country:US
Practice Address - Phone:860-442-1133
Practice Address - Fax:860-442-1133
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000572101YP2500X
CT5445417422103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool