Provider Demographics
NPI:1578844809
Name:MAURO, MARCIE J
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:J
Last Name:MAURO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3078
Mailing Address - Country:US
Mailing Address - Phone:860-334-8830
Mailing Address - Fax:
Practice Address - Street 1:377 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3078
Practice Address - Country:US
Practice Address - Phone:860-334-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist