Healthcare Provider Details

I. General information

NPI: 1497819015
Provider Name (Legal Business Name): LILI DAOUD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W MAIN ST SUITE 6
AVON CT
06001-3685
US

IV. Provider business mailing address

28 AYRSHIRE LN
AVON CT
06001-2102
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-2991
  • Fax: 860-677-6178
Mailing address:
  • Phone: 860-676-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005394
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: