Provider Demographics
NPI:1770719189
Name:COSME, MARLINE (MA MFT)
Entity type:Individual
Prefix:MS
First Name:MARLINE
Middle Name:
Last Name:COSME
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HARTFORD RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5973
Mailing Address - Country:US
Mailing Address - Phone:860-647-2929
Mailing Address - Fax:860-647-2932
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6059
Practice Address - Country:US
Practice Address - Phone:860-647-2929
Practice Address - Fax:860-647-2932
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist