Provider Demographics
NPI:1669487443
Name:MERIANO, CATHERINE ELLEN (JD, MHS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ELLEN
Last Name:MERIANO
Suffix:
Gender:F
Credentials:JD, MHS, OTR/L
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:ELLEN
Other - Last Name:BOURQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118B LIMEWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-481-7051
Mailing Address - Fax:
Practice Address - Street 1:753 BOSTON POST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2749
Practice Address - Country:US
Practice Address - Phone:203-458-6268
Practice Address - Fax:203-458-9230
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1300000690CT01OtherANTHEM PROVIDER ID