Provider Demographics
NPI:1992874580
Name:SHATZ, ETHELLE (MSW)
Entity type:Individual
Prefix:MS
First Name:ETHELLE
Middle Name:
Last Name:SHATZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARSTROM PL
Mailing Address - Street 2:
Mailing Address - City:ROWAYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06853
Mailing Address - Country:US
Mailing Address - Phone:203-838-0167
Mailing Address - Fax:
Practice Address - Street 1:8 HARSTROM PL
Practice Address - Street 2:
Practice Address - City:ROWAYTON
Practice Address - State:CT
Practice Address - Zip Code:06853
Practice Address - Country:US
Practice Address - Phone:203-838-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0003471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
140000347CT01Medicare ID - Type Unspecified