Healthcare Provider Details

I. General information

NPI: 1912783556
Provider Name (Legal Business Name): MARVA DENISE PATTERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WETHERSFIELD AVE
HARTFORD CT
06114-1113
US

IV. Provider business mailing address

PO BOX 380592
EAST HARTFORD CT
06138-0592
US

V. Phone/Fax

Practice location:
  • Phone: 860-296-0094
  • Fax: 860-206-1184
Mailing address:
  • Phone: 860-484-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7429
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: