Provider Demographics
NPI:1063510535
Name:MUSCO, MARY ELIZABETH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MUSCO
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 PIERREMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2366
Mailing Address - Country:US
Mailing Address - Phone:860-826-5987
Mailing Address - Fax:860-826-5987
Practice Address - Street 1:95 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1409
Practice Address - Country:US
Practice Address - Phone:203-573-0264
Practice Address - Fax:203-755-4835
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000344101YP2500X
CT001104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT41000110402Medicare UPIN
CT24000034402Medicare UPIN
CT41000110401Medicare UPIN
CT24000034401Medicare UPIN