Provider Demographics
NPI:1104056506
Name:ADLER, MARJORIE (MS COUNSELING)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3033
Mailing Address - Country:US
Mailing Address - Phone:203-245-5645
Mailing Address - Fax:203-245-5648
Practice Address - Street 1:10 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3033
Practice Address - Country:US
Practice Address - Phone:203-245-5645
Practice Address - Fax:203-245-5648
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional