Provider Demographics
NPI:1194087387
Name:HAQUE, MEGAN JANE (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:HAQUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4248
Mailing Address - Country:US
Mailing Address - Phone:203-892-9289
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST STE 202B
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5848
Practice Address - Country:US
Practice Address - Phone:203-892-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical