Provider Demographics
NPI:1508139437
Name:DJURO, JUAN M (MSW)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:DJURO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:M
Other - Last Name:DJURO GOIRICELAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1470 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3237
Mailing Address - Country:US
Mailing Address - Phone:203-727-7101
Mailing Address - Fax:
Practice Address - Street 1:1470 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3237
Practice Address - Country:US
Practice Address - Phone:203-727-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical