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General NPI Number Information
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NPI Number | 1063510535
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MUSCO LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 95 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06702-1409
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Country | US
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Telephone | 203-573-0264
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Fax | 203-755-4835
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Provider Business Mailing Address
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Address Line | 236 PIERREMOUNT AVE
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City | NEW BRITAIN
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State | CT
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Zip | 06053-2366
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Country | US
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Telephone | 860-826-5987
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Fax | 860-826-5987
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000344
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001104
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License Number State | CT
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