Provider Demographics
NPI:1346526704
Name:DUHAIME, GEORGE JOHN (JD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOHN
Last Name:DUHAIME
Suffix:
Gender:M
Credentials:JD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-2628
Mailing Address - Country:US
Mailing Address - Phone:860-608-7494
Mailing Address - Fax:860-889-6206
Practice Address - Street 1:263 RANDALL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-2628
Practice Address - Country:US
Practice Address - Phone:860-608-7494
Practice Address - Fax:860-889-6206
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical