Healthcare Provider Details

I. General information

NPI: 1578491445
Provider Name (Legal Business Name): MS. MYRA MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BROAD ST STE 204
WINDSOR CT
06095-3030
US

IV. Provider business mailing address

18 MILL ST
NEW BRITAIN CT
06051-3411
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-1684
  • Fax:
Mailing address:
  • Phone: 860-550-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: