Provider Demographics
NPI:1558915454
Name:GEGU, MYRNEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MYRNEL
Middle Name:
Last Name:GEGU
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 1:73 MYRTLE ST APT A2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2109
Mailing Address - Country:US
Mailing Address - Phone:860-967-1126
Mailing Address - Fax:
Practice Address - Street 1:199 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2150
Practice Address - Country:US
Practice Address - Phone:860-967-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty