Provider Demographics
NPI:1154307668
Name:SHEKOSKY, EILEEN L (LCSW/MSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:L
Last Name:SHEKOSKY
Suffix:
Gender:F
Credentials:LCSW/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SAYBROOK RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4739
Mailing Address - Country:US
Mailing Address - Phone:860-343-5388
Mailing Address - Fax:860-343-5391
Practice Address - Street 1:770 SAYBROOK RD
Practice Address - Street 2:BLDG B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4739
Practice Address - Country:US
Practice Address - Phone:860-343-5388
Practice Address - Fax:860-343-5391
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT768882OtherCTCARE
CT140001420CT01OtherANTHEM BLUE CROSS
CT11244569OtherCAQH
CT211825OtherMHN
CT56140001420CT1OtherANTHEM/BLUECROSS
CT80000908Medicare ID - Type Unspecified