Healthcare Provider Details

I. General information

NPI: 1326399213
Provider Name (Legal Business Name): KATHRYNE STUART MARINCHAK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ALLEN PL
HARTFORD CT
06106-3103
US

IV. Provider business mailing address

135 ALLEN PL
HARTFORD CT
06106-3103
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-2414
  • Fax:
Mailing address:
  • Phone: 860-297-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3239
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: