Provider Demographics
NPI:1467895672
Name:PARENT, MARC EDWARD (LADC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:EDWARD
Last Name:PARENT
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2901
Mailing Address - Country:US
Mailing Address - Phone:860-761-7922
Mailing Address - Fax:860-761-7928
Practice Address - Street 1:330 MARKET ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2901
Practice Address - Country:US
Practice Address - Phone:860-761-7922
Practice Address - Fax:860-761-7928
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042-000792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042-000792OtherCT STATE PUBLIC HEALTH LICENSE