Provider Demographics
NPI:1790907640
Name:PACHECO, ANN MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MANSFIELD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1314
Mailing Address - Country:US
Mailing Address - Phone:860-423-0877
Mailing Address - Fax:860-423-0877
Practice Address - Street 1:2 MANSFIELD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1314
Practice Address - Country:US
Practice Address - Phone:860-423-0877
Practice Address - Fax:860-423-0877
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004202008Medicaid