Healthcare Provider Details

I. General information

NPI: 1841569449
Provider Name (Legal Business Name): GAIL MARIE MARQUEZ LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BRIDGE ST
GREENWICH CT
06830-5238
US

IV. Provider business mailing address

20 BRIDGE ST
GREENWICH CT
06830-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-629-2822
  • Fax:
Mailing address:
  • Phone: 203-629-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005788
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002825
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: