Healthcare Provider Details

I. General information

NPI: 1942417514
Provider Name (Legal Business Name): MARSHA R BELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 BOSTON POST RD SUITE 202
ORANGE CT
06477-3523
US

IV. Provider business mailing address

1890 DIXWELL AVE SUITE 207
HAMDEN CT
06514-3122
US

V. Phone/Fax

Practice location:
  • Phone: 203-799-0138
  • Fax: 203-795-2727
Mailing address:
  • Phone: 203-407-6444
  • Fax: 203-407-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001505
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: