Provider Demographics
NPI:1235935057
Name:WHITTAKER, SHAKENYA (LPCA)
Entity type:Individual
Prefix:
First Name:SHAKENYA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 MADISON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3565
Mailing Address - Country:US
Mailing Address - Phone:203-414-9330
Mailing Address - Fax:
Practice Address - Street 1:4154 MADISON AVE
Practice Address - Street 2:STE 102
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-414-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health