Provider Demographics
NPI:1518056647
Name:THOMEN, MARY ANN (MA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:THOMEN
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 1:219 BROAD ST
Mailing Address - Street 2:PO BOX 292
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-0292
Mailing Address - Country:US
Mailing Address - Phone:860-779-2402
Mailing Address - Fax:
Practice Address - Street 1:219 BROAD ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3004
Practice Address - Country:US
Practice Address - Phone:860-779-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist