MEDICARE: MS. MARION BELANGER L.M.F.T.

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
1	106H00000X	Marriage & Family Therapist	0006333	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410000633CT04	OTHER	CT	ANTHEM

General Provider Information

NPI Number	:	1932228301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARION BELANGER L.M.F.T.

Provider Business Mailing Address
First Line	:	36 BARKER HILL DR
Second Line	:
City	:	GUILFORD
State	:	CT
Zip	:	06437-2351
Country	:	US
Telephone Number	:	203-458-6923
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 BARKER HILL DR
Second Line	:
City	:	GUILFORD
State	:	CT
Zip	:	06437-2351
Country	:	US
Telephone Number	:	203-458-6923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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