MARIE T. CLAVECILLA-CHAN (NPI# 1598807810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598807810 |
| Entity Type | Individual |
| Full Name | MARIE T. CLAVECILLA-CHAN |
| Other Name | MARIE T. CUSTODIO |
| Credential | M.A. |
| Practice Address |
100 Market Sq Suite # 10 Newington CT 06111-2921 |
| Practice Telephone | 8606651025 |
| Practice Fax Number | 8606676008 |
| Mailing Telephone | 8606651025 |
| Mailing Fax Number | 8606676008 |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-11-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
001481 | CT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | CT MEDICAL ASSITANCE PROG | 004257912 | 01 |
| CT | ANTHEM BEHAVIORAL HEALTH | 240001481CT01 | 01 |
| Street Address |
100 MARKET SQ SUITE # 10 |
| City | NEWINGTON |
| State | CT |
| Zip Code | 06111-2921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114988326 | Jay Jude Schuder | Counselor | 100 Market Sq, Suite 5, Newington, CT 06111-2921 | 2006-03-29 |
| 1306216395 | Evan James Piasecki | Massage Therapist | 100 Market Sq, Suite 1, Newington, CT 06111-2921 | 2015-10-02 |
| 1003209115 | Azalea Counseling & Wellness, LLC | Community/Behavioral Health | 100 Market Sq, Suite 16a, Newington, CT 06111-2921 | 2015-03-13 |
| 1497918973 | Jennifer Elizabeth Brady | Social Worker | 100 Market Sq, Suite 16a, Newington, CT 06111-2921 | 2008-07-06 |
| 1790952745 | Sleepmed Therapies Inc | Durable Medical Equipment & Medical Supplies | 100 Market Sq, Suite 12, Newington, CT 06111-2921 | 2008-05-09 |
| 1316127137 | Mitchell Kenneth Page | Social Worker | 100 Market Sq, # 7, Newington, CT 06111-2921 | 2007-11-08 |
| 1912063330 | Ronald M Backer | Counselor | 100 Market Sq, Suite #6, Newington, CT 06111-2921 | 2006-12-29 |
| 1770689523 | Digitrace Care Services, Inc. | Clinic/Center | 100 Market Sq, Suite 12, Newington, CT 06111-2921 | 2006-09-16 |
| 1407968282 | Giuseppina Lisa Pontbriand | Counselor | 100 Market Sq, Suite 10, Newington, CT 06111-2921 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952880056 | Insight To Wellness Therapeutic Services, LLC | Community/Behavioral Health | 66 Cedar St. Suite 201, Newington, CT 06111 | 2018-08-09 |
| 1356843833 | Myeyedr Optometry of Connecticut, LLC | Optometrist | 38 Fenn Road, Newington, CT 06111 | 2018-03-01 |
| 1942719927 | Jessica Quintero-villa | Chiropractor | Judson Family Chiropractic, 133 Louis St., Newington, CT 06111 | 2017-09-22 |
| 1194245993 | Serrita Roper | Registered Nurse | 11 Edward St, Newington, CT 06111 | 2017-06-22 |
| 1417482522 | Aditi Thakkar | Student in an Organized Health Care Education/Training Program | 555 Willard Avenue, Newington Va Hospital, Newington, CT 06111 | 2017-04-26 |
| 1033562525 | Hassan Bin Attique | Student in an Organized Health Care Education/Training Program | Newington Va Hospital, Newington Vamc, Firm Chief, Firm 2, Vact Primary Care, Newington, CT 06111 | 2016-07-19 |
| 1013360098 | Home Care Associates of Ct 2 Inc | In Home Supportive Care | 66 Cedar Street, Unit 301, Newington, CT 06111 | 2016-07-14 |
| 1548623259 | Aniket Sharma | Student in an Organized Health Care Education/Training Program | Newington Va Hospital, 555 Willard Avenue, Newington Vamc, Firm Chief, Firm 2, Vact Pri, Newington, CT 06111 | 2016-03-30 |
| 1790104883 | Patrick Ogurick | Pediatrics | 141 Willard Avenue, Newington, CT 06111 | 2014-04-16 |
| 1922438217 | Susan Pollock May | Dentist | 51 Market Sq., Newington, CT 06111 | 2013-11-22 |
| Find all providers in zip 06111 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303853 | Steps Counseling LLC | Counselor | 182 Candlewyck Dr, Newington, CT 06111-5229 | 2020-10-13 |
| 1265930572 | Sandra Ann Coakley | Counselor | 128 Carriage Hill Dr, Newington, CT 06111-2006 | 2018-02-01 |
| 1740690692 | Ramon Apellaniz | Counselor | 705 N Mountain Rd Ste A-118, Newington, CT 06111-1412 | 2014-04-30 |
| 1326388257 | Jeffrey Ambroise | Counselor | 1268 Main St Ste 106, Newington, CT 06111-3043 | 2013-03-01 |
| 1487960662 | Justine Wallace | Counselor | 419 Cedar St, Newington, CT 06111-1812 | 2010-08-25 |
| 1437297975 | Beverly Shoenberger | Counselor | 221 Kimberley Rd, Newington, CT 06111-1626 | 2007-02-04 |
| 1710059167 | Joan-alice Taylor | Counselor | 9 Elmwood Ct, Newington, CT 06111-1401 | 2006-11-14 |
| 1215020870 | Town of Newington | Counselor | 131 Cedar Street, Newington, CT 06111 | 2006-10-02 |
| 1962519629 | Ada G. Rodriguez | Counselor | 100 Market Sq Ste 14, Newington, CT 06111-2921 | 2006-08-25 |
| 1104425438 | Truth, LLC | Counselor | 66 Cedar St, Newington, CT 06111-2633 | 2020-10-19 |
| Find all providers in NEWINGTON | ||||
Please comment or provide details below to improve the information on MARIE T. CLAVECILLA-CHAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.