Provider Demographics
NPI:1629215538
Name:MERWIN, MARI SHINODA (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:SHINODA
Last Name:MERWIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2118
Mailing Address - Country:US
Mailing Address - Phone:860-951-8770
Mailing Address - Fax:860-233-2796
Practice Address - Street 1:1921 PARK ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2118
Practice Address - Country:US
Practice Address - Phone:860-951-8770
Practice Address - Fax:860-233-2796
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health