Healthcare Provider Details

I. General information

NPI: 1508139437
Provider Name (Legal Business Name): JUAN M DJURO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JUAN M DJURO GOIRICELAYA MSW

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 05/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BARNUM AVE
BRIDGEPORT CT
06610-3237
US

IV. Provider business mailing address

1470 BARNUM AVE
BRIDGEPORT CT
06610-3237
US

V. Phone/Fax

Practice location:
  • Phone: 203-727-7101
  • Fax:
Mailing address:
  • Phone: 203-727-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: