Provider Demographics
NPI:1598882227
Name:COURTEMANCHE, MARIE (LADC,CAC,SCCD)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:COURTEMANCHE
Suffix:
Gender:F
Credentials:LADC,CAC,SCCD
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:SANTOPIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC,CAC,SCCD
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1701
Practice Address - Country:US
Practice Address - Phone:203-755-1143
Practice Address - Fax:203-755-1147
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC-SCCD 4441101Y00000X
CT000563101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor