Provider Demographics
NPI:1316560089
Name:MARCIL, SEAN THOMAS (CADC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:MARCIL
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 PEARL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-2528
Mailing Address - Country:US
Mailing Address - Phone:203-528-8701
Mailing Address - Fax:
Practice Address - Street 1:1776 MERIDEN RD REAR UNITB
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-3341
Practice Address - Country:US
Practice Address - Phone:203-528-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)