Provider Demographics
NPI:1699335372
Name:DAIGNEAULT, CYNTHIA (LCSW, LADC, EMT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:LCSW, LADC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-0033
Mailing Address - Country:US
Mailing Address - Phone:860-710-7312
Mailing Address - Fax:860-599-3988
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2324
Practice Address - Country:US
Practice Address - Phone:860-694-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001310101YA0400X
CT41411041C0700X
CT941502146N00000X
RICSW021371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICSW02137Medicaid
CT001310Medicaid
CT941502Medicaid
CT4141Medicaid