Healthcare Provider Details

I. General information

NPI: 1114868312
Provider Name (Legal Business Name): GRETCHEN MILLER MARINO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 BRADLEY ST APT 1
NEW HAVEN CT
06511-6204
US

IV. Provider business mailing address

158 BRADLEY ST APT 1R
NEW HAVEN CT
06511-6204
US

V. Phone/Fax

Practice location:
  • Phone: 203-494-7580
  • Fax:
Mailing address:
  • Phone: 203-494-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10926
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: