MEDICARE: MRS. ELIZABETH MACCHI 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	001202	CT

General Provider Information

NPI Number	:	1629127808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH MACCHI LADC

Provider Business Mailing Address
First Line	:	270 FARMINGTON AVE STE 328
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 E MAIN ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06051-2042
Country	:	US
Telephone Number	:	860-827-3313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	04/02/2024

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