Provider Demographics
NPI:1083914824
Name:MARCIL, GERARD (LADC)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:MARCIL
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1240
Mailing Address - Country:US
Mailing Address - Phone:203-596-7870
Mailing Address - Fax:203-527-7683
Practice Address - Street 1:525 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1240
Practice Address - Country:US
Practice Address - Phone:203-596-7870
Practice Address - Fax:203-527-7683
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)