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General NPI Number Information
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NPI Number | 1134489461
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Entity Type | Individual
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Provider Name | LEIGH ANNE SHIELDS-CHURCH LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 34 PARK STREET RM #206
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City | NEW HAVEN
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State | CT
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Zip | 06519
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Country | US
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Telephone | 203-974-7841
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Fax | 203-974-7322
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Provider Business Mailing Address
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Address Line | 34 PARK STREET RM #206
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City | NEW HAVEN
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State | CT
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Zip | 06519
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Country | US
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Telephone | 203-974-7841
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Fax | 203-974-7322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007363
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License Number State | CT
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