Provider Information for 1053723205
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MARISSA BELANGER
Sex: Female
NPI: 1053723205
Last Updated: 2024-11-01
Certification Date: 2024-11-01
Certification Date: 2024-11-01
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053723205 | ||||||||
| Enumeration Date | 2014-05-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5 VALLEY VIEW CIR ENFIELD, CT 06082-3926 United States Phone: 978-501-5099 | Fax: | ||||||||
| Primary Practice Address | 5 VALLEY VIEW CIR ENFIELD, CT 06082-3926 United States Phone: 978-501-5099 | Fax: | ||||||||
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