Healthcare Provider Details

I. General information

NPI: 1073287959
Provider Name (Legal Business Name): MARISA KELSEY SIERRA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SCHOOL ST
MADISON CT
06443-3033
US

IV. Provider business mailing address

10 SCHOOL ST
MADISON CT
06443-3033
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-5645
  • Fax: 203-245-0078
Mailing address:
  • Phone: 203-245-5645
  • Fax: 203-245-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: