Provider Demographics
NPI:1427499458
Name:BAXLEY, SHARON DEANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DEANE
Last Name:BAXLEY
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 1:259 BROOKLYN RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-1138
Mailing Address - Country:US
Mailing Address - Phone:860-501-6065
Mailing Address - Fax:860-400-3042
Practice Address - Street 1:10 FORT HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4757
Practice Address - Country:US
Practice Address - Phone:860-501-6065
Practice Address - Fax:860-400-3042
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0068131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical