Provider Demographics
NPI:1992281950
Name:MARTIN, SHAUNE CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:
First Name:SHAUNE
Middle Name:CHRISTOPHER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W BROAD ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-4307
Mailing Address - Country:US
Mailing Address - Phone:860-245-8548
Mailing Address - Fax:
Practice Address - Street 1:43 W BROAD ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-4307
Practice Address - Country:US
Practice Address - Phone:860-245-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0108991041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical