=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124675970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN GARCEAU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2019
-----------------------------------------------------
Last Update Date | 01/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 SOUTH ST
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06759-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-567-4437
-----------------------------------------------------
Fax | 860-567-0300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1549
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06759-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-567-4437
-----------------------------------------------------
Fax | 860-567-0300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13596
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------