Provider Demographics
NPI:1437701497
Name:MARTELL, DENYCE MARIE (MS-MFT)
Entity Type:Individual
Prefix:
First Name:DENYCE
Middle Name:MARIE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MS-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HEMPSTEAD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5638
Mailing Address - Country:US
Mailing Address - Phone:860-444-8774
Mailing Address - Fax:860-444-8776
Practice Address - Street 1:154 HEMPSTEAD ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5638
Practice Address - Country:US
Practice Address - Phone:860-444-8774
Practice Address - Fax:860-444-8776
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist