Individual
MS. MARI JO MACINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
163 BOSTON POST ROAD SUITE 384, WATERFORD, CT 06385
(860) 444-8774
(860) 444-8776
Mailing address
163 BOSTON POST ROAD SUITE 384, PO BOX 328, WATERFORD, CT 06385
(860) 444-8774
(860) 444-8776
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000917
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410000917CT09
BCBS
CT
Enumeration date
11/16/2006
Last updated
07/08/2007
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