Provider Demographics
NPI:1114023744
Name:KAIN, MARILYN CARLSON (LPC LADC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:CARLSON
Last Name:KAIN
Suffix:
Gender:F
Credentials:LPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:SUITE 2A LANDMARK OFFICE BUILDING
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-775-3282
Mailing Address - Fax:203-775-3478
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3282
Practice Address - Fax:203-775-3282
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLPC000560101Y00000X
CTLADC000053101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
300000053CT01OtherANTHEM LADC
2158751OtherCIGNA
347934OtherMHN
240000560CT01OtherLPC ANTHEM