Provider Demographics
NPI:1457461758
Name:STANSBURY, MARIAN LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:LEE
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3490
Mailing Address - Country:US
Mailing Address - Phone:203-878-9560
Mailing Address - Fax:203-783-3093
Practice Address - Street 1:63 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3490
Practice Address - Country:US
Practice Address - Phone:203-878-9560
Practice Address - Fax:203-783-3093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist