Healthcare Provider Details

I. General information

NPI: 1528962214
Provider Name (Legal Business Name): MARIA C SEGULJIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA C FUNK LPCA

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 LITWIN RD
LITCHFIELD CT
06759-3113
US

IV. Provider business mailing address

71 LITWIN RD
LITCHFIELD CT
06759-3113
US

V. Phone/Fax

Practice location:
  • Phone: 860-919-9881
  • Fax:
Mailing address:
  • Phone: 860-919-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8623
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: