Healthcare Provider Details

I. General information

NPI: 1568731636
Provider Name (Legal Business Name): MARGUERITE NICOLA YOUNGREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COTTAGE GROVE RD STE 107
BLOOMFIELD CT
06002-3088
US

IV. Provider business mailing address

580 COTTAGE GROVE RD STE 107
BLOOMFIELD CT
06002-3088
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-8709
  • Fax: 860-243-8259
Mailing address:
  • Phone: 860-243-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78958
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: