Provider Demographics
NPI:1235764804
Name:MARMOR, SYDNI (LPC)
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:
Last Name:MARMOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SYDNI
Other - Middle Name:
Other - Last Name:CAMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 OPENING HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-8203
Mailing Address - Country:US
Mailing Address - Phone:203-521-2439
Mailing Address - Fax:
Practice Address - Street 1:17 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1826
Practice Address - Country:US
Practice Address - Phone:860-258-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health