MEDICARE: JOHN BEAZOGLOU LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	005815	CT

General Provider Information

NPI Number	:	1750453817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BEAZOGLOU LCSW

Provider Business Mailing Address
First Line	:	21 WALTON DR
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1631
Country	:	US
Telephone Number	:	860-313-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 FARMINGTON AVE STE 303
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2673
Country	:	US
Telephone Number	:	860-810-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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