Provider Demographics
NPI:1427137108
Name:MARQUEZ, MARIETTA AM (CIT)
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:AM
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 SLATER RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2240
Mailing Address - Country:US
Mailing Address - Phone:860-229-8871
Mailing Address - Fax:
Practice Address - Street 1:90 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2607
Practice Address - Country:US
Practice Address - Phone:860-225-3561
Practice Address - Fax:860-225-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)