Healthcare Provider Details

I. General information

NPI: 1730872425
Provider Name (Legal Business Name): SHANAE MONIQUE LYNCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 HOWE AVE
SHELTON CT
06484-3323
US

IV. Provider business mailing address

183 HOWE AVE
SHELTON CT
06484-3323
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-1117
  • Fax: 949-561-4769
Mailing address:
  • Phone: 203-929-1117
  • Fax: 949-561-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16281
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: