Provider Demographics
NPI:1336311786
Name:MARCANO-DAVIS, CARMEN ROSA (PHD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:MARCANO-DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1917
Mailing Address - Country:US
Mailing Address - Phone:203-301-3330
Mailing Address - Fax:
Practice Address - Street 1:945 W RIVER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1917
Practice Address - Country:US
Practice Address - Phone:203-301-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid