Provider Demographics
NPI:1801268099
Name:KLIMOVA, MARINA (LMFT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KLIMOVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2548
Mailing Address - Country:US
Mailing Address - Phone:203-362-7631
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2548
Practice Address - Country:US
Practice Address - Phone:203-362-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist