Provider Demographics
NPI:1629183256
Name:SCHWARTZ, MARION E (LCSW)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:E
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NUTMEG LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1611
Mailing Address - Country:US
Mailing Address - Phone:860-242-3531
Mailing Address - Fax:860-649-6751
Practice Address - Street 1:543 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1935
Practice Address - Country:US
Practice Address - Phone:860-646-7553
Practice Address - Fax:860-649-6751
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004748104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004231528Medicaid