Provider Demographics
NPI:1699579904
Name:GIGUERE, SAMUEL FRANKLIN
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:FRANKLIN
Last Name:GIGUERE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:S GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3303
Mailing Address - Country:US
Mailing Address - Phone:860-709-8268
Mailing Address - Fax:
Practice Address - Street 1:90 FAIRVIEW TER
Practice Address - Street 2:
Practice Address - City:S GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-3303
Practice Address - Country:US
Practice Address - Phone:860-709-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0150841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical