Provider Demographics
NPI:1891535563
Name:MARCANO, KRISTEN ALEXIS (LMSW)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:ALEXIS
Last Name:MARCANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MATTABASSET DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7431
Mailing Address - Country:US
Mailing Address - Phone:203-843-3655
Mailing Address - Fax:
Practice Address - Street 1:1006 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-7609
Practice Address - Country:US
Practice Address - Phone:860-385-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9840104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker