Provider Demographics
NPI:1235528654
Name:DUVALL, TINA (MSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:DUVALL
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 1:1007 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2170
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:860-779-5437
Practice Address - Street 1:233 ROUTE 6
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1125
Practice Address - Country:US
Practice Address - Phone:860-228-4480
Practice Address - Fax:860-779-5437
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid