Healthcare Provider Details

I. General information

NPI: 1629237375
Provider Name (Legal Business Name): MARTHA T BARATT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 06/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 SAYBROOK RD
HADDAM CT
06438-1318
US

IV. Provider business mailing address

59 BAKER LN
EAST HADDAM CT
06423-1734
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-1090
  • Fax:
Mailing address:
  • Phone: 860-345-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003979
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: