Healthcare Provider Details

I. General information

NPI: 1154160430
Provider Name (Legal Business Name): ELIZABETH CHRISTINE MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

IV. Provider business mailing address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

V. Phone/Fax

Practice location:
  • Phone: 860-947-1341
  • Fax:
Mailing address:
  • Phone: 860-527-1124
  • Fax: 860-724-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8951
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: