Provider Demographics
NPI:1669517884
Name:ALBINI, MARYELLEN LUGENE (CPM PT)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:LUGENE
Last Name:ALBINI
Suffix:
Gender:F
Credentials:CPM PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:25 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-4036
Mailing Address - Country:US
Mailing Address - Phone:203-468-8026
Mailing Address - Fax:203-468-8026
Practice Address - Street 1:25 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-4036
Practice Address - Country:US
Practice Address - Phone:203-468-8026
Practice Address - Fax:203-468-8026
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
98040010176B00000X
CT004682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered176B00000XOther Service ProvidersMidwife
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist