Healthcare Provider Details

I. General information

NPI: 1164400016
Provider Name (Legal Business Name): SHARON ELIZABETH SHEA LCSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PARTRIDGE LN
NEW MILFORD CT
06776-3057
US

IV. Provider business mailing address

6 PARTRIDGE LN
NEW MILFORD CT
06776-3057
US

V. Phone/Fax

Practice location:
  • Phone: 203-744-9737
  • Fax: 203-529-0581
Mailing address:
  • Phone: 203-744-9737
  • Fax: 203-529-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number291
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3991
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: