Individual
MARIE T. CLAVECILLA-CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
100 MARKET SQ, SUITE # 10, NEWINGTON, CT 06111-2921
(860) 665-1025
(860) 667-6008
Mailing address
100 MARKET SQ, SUITE # 10, NEWINGTON, CT 06111-2921
(860) 665-1025
(860) 667-6008
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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