Provider Demographics
NPI:1710740055
Name:DUHAIME, MYRA
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:DUHAIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:DAOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1307
Mailing Address - Country:US
Mailing Address - Phone:860-930-5221
Mailing Address - Fax:
Practice Address - Street 1:49 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1102
Practice Address - Country:US
Practice Address - Phone:860-480-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist