MEDICARE: MARTHA T BARATT LCSW

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	1041C0700X	Clinical Social Worker	003979	CT

General Provider Information

NPI Number	:	1629237375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA T BARATT LCSW

Provider Business Mailing Address
First Line	:	59 BAKER LN
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1734
Country	:	US
Telephone Number	:	860-345-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1588 SAYBROOK RD
Second Line	:
City	:	HADDAM
State	:	CT
Zip	:	06438-1318
Country	:	US
Telephone Number	:	860-345-1090
Fax Number	:

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

Provider Enumeration Date	:	06/07/2008
Last Update Date	:	06/07/2008

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