MEDICARE: MARIANNE CARDILLO LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578979332	OTHER		NPI

General Provider Information

NPI Number	:	1548867823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIANNE CARDILLO LLC

Provider Business Mailing Address
First Line	:	72 CEDAR HEIGHTS RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-1105
Country	:	US
Telephone Number	:	203-253-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 CEDAR HEIGHTS RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-1105
Country	:	US
Telephone Number	:	203-253-6167
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIANNE CARDILLO
Credential	:	LMFT
Telephone Number	:	203-253-6167

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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Directions to “MARIANNE CARDILLO LLC ” Practice Location

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