Healthcare Provider Details

I. General information

NPI: 1427122258
Provider Name (Legal Business Name): RUTH E. MARCIAL PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE UNITED SERVICES, INC.
WILLIMANTIC CT
06226-2027
US

IV. Provider business mailing address

11 GREGORY RD APT C
NORWICH CT
06360-6033
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax:
Mailing address:
  • Phone: 869-865-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2007
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: