Provider Demographics
NPI:1982078796
Name:GARYCH, MAURA
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:GARYCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:166 CHRISTIAN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-1504
Mailing Address - Country:US
Mailing Address - Phone:860-965-1938
Mailing Address - Fax:
Practice Address - Street 1:1214 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6008
Practice Address - Country:US
Practice Address - Phone:203-743-4412
Practice Address - Fax:203-738-1188
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional