Healthcare Provider Details

I. General information

NPI: 1316461312
Provider Name (Legal Business Name): SALLI SHON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MULBERRY LN
AVON CT
06001-4525
US

IV. Provider business mailing address

10 MULBERRY LN
AVON CT
06001-4525
US

V. Phone/Fax

Practice location:
  • Phone: 860-508-2908
  • Fax:
Mailing address:
  • Phone: 860-508-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SALLI UNHONG SHON
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: LCSW, BCBA
Phone: 860-508-2908