Healthcare Provider Details

I. General information

NPI: 1861859944
Provider Name (Legal Business Name): COLLEEN A MAROTTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 PADDOCK AVE
MERIDEN CT
06450-7044
US

IV. Provider business mailing address

67 TRUMBULL ST
NEW HAVEN CT
06510-1004
US

V. Phone/Fax

Practice location:
  • Phone: 203-630-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number009271
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: