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General NPI Number Information
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NPI Number | 1639430937
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Entity Type | Organization
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Legal Business Name | FREDERIQUE SHEA, LMFT, LLC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 660 PROSPECT AVE
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City | HARTFORD
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State | CT
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Zip | 06105-4230
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Country | US
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Telephone | 860-713-4654
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Fax |
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Provider Business Mailing Address
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Address Line | 325 N QUAKER LN
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1036
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Country | US
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Telephone | 860-713-4654
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE AND FAMILY THERAP
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Name | FREDERIQUE SHEA
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Credential | MA
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Telephone | 860-713-4654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001490
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License Number State | CT
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