Provider Demographics
NPI:1194093864
Name:OWEN, SHEILA A (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:OWEN
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BROADWAY
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-494-2824
Mailing Address - Fax:
Practice Address - Street 1:16 BROADWAY
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-494-2824
Practice Address - Fax:203-230-0559
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000705101YA0400X
CT90761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003745Medicaid
CT004041000Medicaid
CT008038041Medicaid
CT008038041Medicaid