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Individual
MARIE T. CLAVECILLA-CHAN
Active
Individual
MARIE T. CLAVECILLA-CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001481
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004257912
CT MEDICAL ASSITANCE PROG
CT
01
—
240001481CT01
ANTHEM BEHAVIORAL HEALTH
CT
Enumeration date
02/13/2007
Last updated
11/16/2007
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