MEDICARE: MR. DUANE C. SHEA-DAGUIO MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	002335	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002335	OTHER	CT	LCSW

General Provider Information

NPI Number	:	1396709465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE C. SHEA-DAGUIO MSW

Provider Business Mailing Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3309
Country	:	US
Telephone Number	:	860-545-7330
Fax Number	:	860-545-7288

Provider Business Practice Location Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3309
Country	:	US
Telephone Number	:	860-545-7330
Fax Number	:	860-545-7288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/17/2018

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