Provider Demographics
NPI:1972159390
Name:MARC J MANN PHD
Entity type:Organization
Organization Name:MARC J MANN PHD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:860-329-6356
Mailing Address - Street 1:42 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-7956
Mailing Address - Country:US
Mailing Address - Phone:860-329-6357
Mailing Address - Fax:860-606-9678
Practice Address - Street 1:42 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-7956
Practice Address - Country:US
Practice Address - Phone:860-329-6357
Practice Address - Fax:860-606-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008032230Medicaid
CT2064455939OtherANTHEM