Provider Demographics
NPI:1912515701
Name:SHEA, ANNE WHITNEY (LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:WHITNEY
Last Name:SHEA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:A.
Other - Middle Name:WHITNEY
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:UNIT 5260 BOX 84
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09759-0084
Mailing Address - Country:US
Mailing Address - Phone:860-249-1720
Mailing Address - Fax:
Practice Address - Street 1:141B STRADA EROU IANCU NICOLAE
Practice Address - Street 2:
Practice Address - City:VOLUNTARI
Practice Address - State:BUCHAREST
Practice Address - Zip Code:077190
Practice Address - Country:RO
Practice Address - Phone:860-249-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL364101YM0800X
CT4499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health