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General NPI Number Information
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NPI Number | 1770465122
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Entity Type | Individual
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Provider Name | ELIZABETH JOY MARJORAM RBT, CPR
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 114 MAIN ST STE G
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City | EAST HARTFORD
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State | CT
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Zip | 06118-3211
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Country | US
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Telephone | 888-754-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 419 S STONE ST
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City | WEST SUFFIELD
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State | CT
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Zip | 06093-3220
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Country | US
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Telephone | 931-316-5406
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1241584
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License Number State | VA
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