Provider Demographics
NPI:1841661469
Name:LAURA M. SHIRES, LCSW, LLC
Entity type:Organization
Organization Name:LAURA M. SHIRES, LCSW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRES
Authorized Official - Suffix:I
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-989-0422
Mailing Address - Street 1:24 LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2106
Mailing Address - Country:US
Mailing Address - Phone:860-989-0422
Mailing Address - Fax:860-395-0184
Practice Address - Street 1:24 LEDGE ROAD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-989-0422
Practice Address - Fax:860-395-0184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURA M. SHIRES, LCSW, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty