Healthcare Provider Details

I. General information

NPI: 1932386216
Provider Name (Legal Business Name): MARIANNE G. THOMAS M.S.,C.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PINE ST
NEW CANAAN CT
06840-5425
US

IV. Provider business mailing address

154 INDIAN ROCK RD
NEW CANAAN CT
06840-3117
US

V. Phone/Fax

Practice location:
  • Phone: 203-966-6047
  • Fax:
Mailing address:
  • Phone: 203-966-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number21604
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number21604
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: