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NPI Code Detail

MEDICARE: DENNIS AUREL GOGUEN MSW, LCSW

MEDICARE: DENNIS AUREL GOGUEN MSW, LCSW
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
11041C0700XClinical Social Worker006063CT

General Provider Information

NPI Number : 1851339782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS AUREL GOGUEN MSW, LCSW
Provider Business Mailing Address
First Line : 95 LIBERTY ST
Second Line :
City : CLINTON
State : CT
Zip : 06413-2418
Country : US
Telephone Number : 860-304-2382
Fax Number :
Provider Business Practice Location Address
First Line : 428 LONG HILL RD
Second Line :
City : GROTON
State : CT
Zip : 06340-3811
Country : US
Telephone Number : 860-391-6049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 09/26/2020

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