Provider Demographics
NPI:1245371558
Name:VANCE, SHARON ANN (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:VANCE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:VANCE WINKLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:202 SEYMOUR ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-605-1495
Mailing Address - Fax:
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 903 WOODBRIDGE OFFICE PARK
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525
Practice Address - Country:US
Practice Address - Phone:203-605-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0046911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2749517OtherOXFORD HEALTH INSURANCE
CT222450OtherMHN
CT117791OtherANTHEM BCBS