Provider Demographics
NPI:1124196753
Name:HEALD, MARLENE HARRIET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:HARRIET
Last Name:HEALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 TAFT POND RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-1315
Mailing Address - Country:US
Mailing Address - Phone:860-974-1047
Mailing Address - Fax:860-974-1047
Practice Address - Street 1:493 TAFT POND RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-1315
Practice Address - Country:US
Practice Address - Phone:860-974-1047
Practice Address - Fax:860-974-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5941591OtherAETNA
CT140002243CT01OtherANTHEM
CT304694OtherHEALTHNET