Provider Demographics
NPI:1245734870
Name:GEDNEY-RUBEL, SHIRLEY (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:GEDNEY-RUBEL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WOOSTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6062
Mailing Address - Country:US
Mailing Address - Phone:203-685-6135
Mailing Address - Fax:203-902-1060
Practice Address - Street 1:44 PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3126
Practice Address - Country:US
Practice Address - Phone:203-898-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health