Provider Demographics
NPI:1285808295
Name:SHIRES, LAURA MAE I (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MAE
Last Name:SHIRES
Suffix:I
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:MAE
Other - Last Name:SHIRES-MESSNER
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 RETREAT AVENUE
Mailing Address - Street 2:HARTFORD HOSPITAL PSYCHIATRY DEPT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3309
Mailing Address - Country:US
Mailing Address - Phone:860-545-7229
Mailing Address - Fax:
Practice Address - Street 1:200 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL PSYCHIATRY DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3309
Practice Address - Country:US
Practice Address - Phone:860-545-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical