Provider Demographics
NPI:1548701808
Name:SHAIA, STACEY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:SHAIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-0233
Mailing Address - Country:US
Mailing Address - Phone:860-465-7812
Mailing Address - Fax:
Practice Address - Street 1:20 BATTERSON PARK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-4502
Practice Address - Country:US
Practice Address - Phone:860-284-1177
Practice Address - Fax:860-284-1125
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical