Healthcare Provider Details

I. General information

NPI: 1952723413
Provider Name (Legal Business Name): CARLOS MARRERO LCSW, GAL, EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 NEW BRITAIN AVE
HARTFORD CT
06106-4033
US

IV. Provider business mailing address

602 NEW BRITAIN AVE
HARTFORD CT
06106-4033
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-0975
  • Fax: 833-968-2486
Mailing address:
  • Phone: 608-762-7488
  • Fax: 860-241-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: