Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 002569 | CT |
Y | 103TC0700X | Clinical Psychologist | 002569 | CT |
NPI | 1003243866 |
---|---|
Provider Name | Dr. John Matthew Mariani |
First Address | Manchester, CT 06042-3581 |
Second Address | Manchester, CT 06042-3581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2013 |
Last Update Date | 10/10/2013 |