Healthcare Provider Details

I. General information

NPI: 1710639802
Provider Name (Legal Business Name): JUDITH ANNE, MARGARET DELAUGERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST AVE
NORWALK CT
06851-5703
US

IV. Provider business mailing address

4042 CONGRESS ST
FAIRFIELD CT
06824-2041
US

V. Phone/Fax

Practice location:
  • Phone: 203-750-9711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: