Provider Demographics
NPI:1326399213
Name:MARINCHAK, KATHRYNE STUART (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYNE
Middle Name:STUART
Last Name:MARINCHAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3103
Mailing Address - Country:US
Mailing Address - Phone:860-297-2414
Mailing Address - Fax:
Practice Address - Street 1:135 ALLEN PL
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3103
Practice Address - Country:US
Practice Address - Phone:860-297-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical