Provider Demographics
NPI:1851510879
Name:FONTANELLA, MARION J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:J
Last Name:FONTANELLA
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 1:86 WOODMERE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-233-0529
Mailing Address - Fax:
Practice Address - Street 1:34 MURRAY STREET
Practice Address - Street 2:FAMILY SERVICES OF GREATER WATERBURY
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710
Practice Address - Country:US
Practice Address - Phone:203-756-8317
Practice Address - Fax:203-756-8310
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical