Healthcare Provider Details

I. General information

NPI: 1942936232
Provider Name (Legal Business Name): SHAILEE EDMONDS LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD PARK LANE RD STE 2A
NEW MILFORD CT
06776-2530
US

IV. Provider business mailing address

15 OLD PARK LANE RD STE 2A
NEW MILFORD CT
06776-2530
US

V. Phone/Fax

Practice location:
  • Phone: 860-799-5750
  • Fax: 860-969-1978
Mailing address:
  • Phone: 860-799-5750
  • Fax: 860-969-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001452
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6549
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: