Healthcare Provider Details

I. General information

NPI: 1114810397
Provider Name (Legal Business Name): EMPOWERED DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 NEW BRITAIN AVE
HARTFORD CT
06106-4033
US

IV. Provider business mailing address

231 MAPLE ST
EAST HARTFORD CT
06118-2730
US

V. Phone/Fax

Practice location:
  • Phone: 475-400-9477
  • Fax:
Mailing address:
  • Phone: 475-400-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS MARRERO
Title or Position: OWNER
Credential: EDD
Phone: 475-400-9477