1194093864 NPI number — SHEILA A OWEN LCSW, LADC

Table of content: SHEILA A OWEN LCSW, LADC (NPI 1194093864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194093864 NPI number — SHEILA A OWEN LCSW, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWEN
Provider First Name:
SHEILA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194093864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 BROADWAY
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-494-2824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 BROADWAY
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-494-2824
Provider Business Practice Location Address Fax Number:
203-230-0559
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000705 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 9076 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008003745 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004041000 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008038041 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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