Provider Demographics
NPI:1437485083
Name:BERUBE, MAUREEN MCCARTHY (MFT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCCARTHY
Last Name:BERUBE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ELIZABETH
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:16 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1309
Mailing Address - Country:US
Mailing Address - Phone:860-322-4336
Mailing Address - Fax:917-414-1371
Practice Address - Street 1:16 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1309
Practice Address - Country:US
Practice Address - Phone:860-322-4336
Practice Address - Fax:917-414-1371
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid