Provider Demographics
NPI:1457687006
Name:MCCAFFREY, MARJORIE (MA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2514
Mailing Address - Country:US
Mailing Address - Phone:203-503-3336
Mailing Address - Fax:
Practice Address - Street 1:62 GRANT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-2514
Practice Address - Country:US
Practice Address - Phone:203-503-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid