Provider Demographics
NPI:1912551003
Name:MARTA SOUTHWORTH LLC
Entity Type:Organization
Organization Name:MARTA SOUTHWORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-305-3585
Mailing Address - Street 1:41 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2448
Mailing Address - Country:US
Mailing Address - Phone:860-348-3776
Mailing Address - Fax:860-650-0042
Practice Address - Street 1:41 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2448
Practice Address - Country:US
Practice Address - Phone:860-348-3776
Practice Address - Fax:860-650-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty