Provider Demographics
NPI:1518647452
Name:SERGEON, TAJAE LASHAWN
Entity Type:Individual
Prefix:MISS
First Name:TAJAE
Middle Name:LASHAWN
Last Name:SERGEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 WOODBURY CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5625
Mailing Address - Country:US
Mailing Address - Phone:203-980-7662
Mailing Address - Fax:
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3305
Practice Address - Country:US
Practice Address - Phone:860-282-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical