Provider Demographics
NPI:1962690248
Name:MORITA, MARIKO
Entity type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:MORITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2565
Mailing Address - Country:US
Mailing Address - Phone:860-538-8925
Mailing Address - Fax:
Practice Address - Street 1:90 FRANKLIN SQUARE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-9202
Practice Address - Country:US
Practice Address - Phone:860-225-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist