Provider Demographics
NPI:1932386216
Name:THOMAS, MARIANNE G (MS,CAS)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS,CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 INDIAN ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-3117
Mailing Address - Country:US
Mailing Address - Phone:203-966-6047
Mailing Address - Fax:
Practice Address - Street 1:58 PINE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5425
Practice Address - Country:US
Practice Address - Phone:203-966-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21604101YS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool