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NPI Code Detail

MEDICARE: MR. MARC EDWARD PARENT LADC

MEDICARE: MR. MARC EDWARD PARENT LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor042-000792CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1042-000792OTHERCTCT STATE PUBLIC HEALTH LICENSE

General Provider Information

NPI Number : 1467895672
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC EDWARD PARENT LADC
Provider Business Mailing Address
First Line : 330 MARKET ST
Second Line :
City : HARTFORD
State : CT
Zip : 06120-2901
Country : US
Telephone Number : 860-761-7922
Fax Number : 860-761-7928
Provider Business Practice Location Address
First Line : 330 MARKET ST
Second Line :
City : HARTFORD
State : CT
Zip : 06120-2901
Country : US
Telephone Number : 860-761-7922
Fax Number : 860-761-7928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2013
Last Update Date : 04/08/2013

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Directions to “ MR. MARC EDWARD PARENT LADC” Practice Location

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