Provider Demographics
NPI:1992082861
Name:SHEA, FREDERIQUE (MA)
Entity type:Individual
Prefix:MS
First Name:FREDERIQUE
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:FREDERIQUE
Other - Middle Name:
Other - Last Name:DENHAENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4230
Mailing Address - Country:US
Mailing Address - Phone:860-713-4654
Mailing Address - Fax:
Practice Address - Street 1:660 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4230
Practice Address - Country:US
Practice Address - Phone:860-713-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist