Provider Demographics
NPI:1669253316
Name:STODDARD, MARIAH (LMSW)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:STODDARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FITCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOZRAH
Mailing Address - State:CT
Mailing Address - Zip Code:06334-1002
Mailing Address - Country:US
Mailing Address - Phone:860-884-3510
Mailing Address - Fax:
Practice Address - Street 1:28 HAUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOZRAH
Practice Address - State:CT
Practice Address - Zip Code:06334-1207
Practice Address - Country:US
Practice Address - Phone:860-917-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker