Provider Demographics
NPI:1881082345
Name:GIACCOTTO, MARISA (LCSW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:GIACCOTTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 JOHN DOWNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2906
Mailing Address - Country:US
Mailing Address - Phone:860-826-1358
Mailing Address - Fax:
Practice Address - Street 1:74 EAST ST
Practice Address - Street 2:SUITE 102 A
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-793-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical