Provider Demographics
NPI:1417028234
Name:DUQUES, MICHEL GEORGES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:GEORGES
Last Name:DUQUES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3717
Mailing Address - Country:US
Mailing Address - Phone:203-624-4457
Mailing Address - Fax:
Practice Address - Street 1:147 BISHOP ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3717
Practice Address - Country:US
Practice Address - Phone:203-624-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004184511Medicaid
CT004184511Medicaid