Provider Demographics
NPI:1528324530
Name:HYACINTH, MARILISE ALEXIS (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARILISE
Middle Name:ALEXIS
Last Name:HYACINTH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:300 GEORGE ST STE 901
Mailing Address - Street 2:YALE DEPARTMENT OF PSYCHIATRY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6662
Mailing Address - Country:US
Mailing Address - Phone:203-688-2259
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:20 YORK ST # T-209
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2259
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0532242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program