Healthcare Provider Details

I. General information

NPI: 1972871887
Provider Name (Legal Business Name): MARTA G. KUTCHER ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WETHERSFIELD AVE
HARTFORD CT
06114-1420
US

IV. Provider business mailing address

331 WETHERSFIELD AVE
HARTFORD CT
06114-1420
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax: 860-231-8449
Mailing address:
  • Phone: 860-236-4511
  • Fax: 860-231-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5336
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: