Provider Demographics
NPI:1881052413
Name:GREENFIELD, MARVA M (PC, MHC, LPCA)
Entity type:Individual
Prefix:MS
First Name:MARVA
Middle Name:M
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:PC, MHC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CORNWALL ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1109
Mailing Address - Country:US
Mailing Address - Phone:860-574-2461
Mailing Address - Fax:
Practice Address - Street 1:370 CORNWALL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1109
Practice Address - Country:US
Practice Address - Phone:860-574-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP1600X
CT6814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral