Provider Demographics
NPI:1770865883
Name:SANTANDREU MIRABAL, MARIAN (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:SANTANDREU MIRABAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:SANTANDREU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 LIBERTY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1109
Mailing Address - Country:US
Mailing Address - Phone:413-200-4110
Mailing Address - Fax:
Practice Address - Street 1:132 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-972-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9906103TC0700X
CT4020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical