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General NPI Number Information
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NPI Number | 1699335372
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Entity Type | Individual
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Provider Name | CYNTHIA DAIGNEAULT LCSW, LADC, EMT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1 WAHOO AVE
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City | GROTON
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State | CT
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Zip | 06349-2324
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Country | US
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Telephone | 860-694-4020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33
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City | NORTH STONINGTON
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State | CT
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Zip | 06359-0033
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Country | US
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Telephone | 860-710-7312
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Fax | 860-599-3988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 001310
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4141
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 941502
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW02137
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License Number State | RI
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