Provider Demographics
NPI:1861699068
Name:DUKES, JOHN TERRY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TERRY
Last Name:DUKES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2032
Mailing Address - Country:US
Mailing Address - Phone:203-807-2769
Mailing Address - Fax:203-404-7126
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2919
Practice Address - Country:US
Practice Address - Phone:203-807-2769
Practice Address - Fax:203-404-7126
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1861699068Medicare PIN