Provider Demographics
NPI:1609144245
Name:NOONAN, JAMES M
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:NOONAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRIDGE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2173
Mailing Address - Country:US
Mailing Address - Phone:860-614-9911
Mailing Address - Fax:
Practice Address - Street 1:68 BRIDGE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2173
Practice Address - Country:US
Practice Address - Phone:860-614-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist