Healthcare Provider Details

I. General information

NPI: 1861210403
Provider Name (Legal Business Name): PATRICK DUVERGER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GROVE BEACH RD N STE 2D
WESTBROOK CT
06498-1656
US

IV. Provider business mailing address

PO BOX 120
NEW LONDON CT
06320-0120
US

V. Phone/Fax

Practice location:
  • Phone: 860-437-4550
  • Fax: 860-661-4262
Mailing address:
  • Phone: 860-437-4550
  • Fax: 860-661-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6489
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: