Provider Demographics
NPI:1619931615
Name:BADE, MARY C (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BADE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3533
Mailing Address - Country:US
Mailing Address - Phone:860-875-2082
Mailing Address - Fax:
Practice Address - Street 1:150 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2003
Practice Address - Country:US
Practice Address - Phone:860-646-1222
Practice Address - Fax:860-647-6819
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health