Basic Information
| Provider Information | |||||||||
| NPI: | 1750594594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIPMAN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LCSW, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LOMBARD ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065132910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606805918 | ||||||||
| FaxNumber: | 8605271919 | ||||||||
| Practice Location | |||||||||
| Address1: | 896 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606805918 | ||||||||
| FaxNumber: | 8605271919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 11/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 8160 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 830 | CT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.