Provider Demographics
NPI:1245305135
Name:SHOCKI, RAYMOND STEVEN (MSW)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:STEVEN
Last Name:SHOCKI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ARROWLEAF CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3312
Mailing Address - Country:US
Mailing Address - Phone:860-628-8474
Mailing Address - Fax:860-621-0850
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:BUILDING 3, SUITE 9
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1565
Practice Address - Country:US
Practice Address - Phone:860-628-8474
Practice Address - Fax:860-621-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004021041C0700X
CT000320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist