Organization
CORE PRINCIPLES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISA FORTI LMT (OWNER)
(860) 604-6068
Entity
Organization
Contact information
Practice address
98 MAIN ST, SOUTHINGTON, CT 06489-2500
(860) 604-6068
Mailing address
98 MAIN ST, SOUTHINGTON, CT 06489-2500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6813
CT
Other
Enumeration date
11/12/2015
Last updated
11/12/2015
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