Provider Demographics
NPI:1972909547
Name:HALLISEY, MARA M I (LMFT)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:M
Last Name:HALLISEY
Suffix:I
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OLD PEWTER LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3134
Mailing Address - Country:US
Mailing Address - Phone:860-306-2986
Mailing Address - Fax:
Practice Address - Street 1:49 OLD PEWTER LN
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3134
Practice Address - Country:US
Practice Address - Phone:860-306-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist