Provider Demographics
NPI:1982797353
Name:SHAKER, PAUL JEFFREY (LCSW, MSW, MDIV)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JEFFREY
Last Name:SHAKER
Suffix:
Gender:M
Credentials:LCSW, MSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2337
Mailing Address - Country:US
Mailing Address - Phone:203-525-8358
Mailing Address - Fax:860-656-6743
Practice Address - Street 1:69 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2337
Practice Address - Country:US
Practice Address - Phone:203-525-8358
Practice Address - Fax:860-656-6743
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical