Provider Demographics
NPI:1497819015
Name:DAOUD, LILI (LCSW)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:DAOUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 AYRSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2102
Mailing Address - Country:US
Mailing Address - Phone:860-676-1239
Mailing Address - Fax:
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3685
Practice Address - Country:US
Practice Address - Phone:860-677-2991
Practice Address - Fax:860-677-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT598297000OtherMAGELLAN
CT322617OtherHEALTH NET
CT140005394CT01OtherANTHEM
CT22771OtherMHN
CT598297000OtherAETNA
CT22771OtherMHN