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General NPI Number Information
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NPI Number | 1679125918
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Entity Type | Individual
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Provider Name | TAYLOR MARIE TACINELLI LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 98 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-5602
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Country | US
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Telephone | 203-843-5624
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Fax |
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Provider Business Mailing Address
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Address Line | 705 LAKE AVE UNIT 24
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City | BRISTOL
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State | CT
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Zip | 06010-7367
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 002087
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License Number State | CT
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