Provider Demographics
NPI:1376074708
Name:GONZALEZ, SHAINA MARIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:SHAINA
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:64 THOMPSON ST STE A104
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-5700
Mailing Address - Country:US
Mailing Address - Phone:203-691-1685
Mailing Address - Fax:
Practice Address - Street 1:20 YORK STREET
Practice Address - Street 2:YALE - NEW HAVEN PSYCHIATRIC HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-906-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT95791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical