Basic Information
Provider Information
NPI: 1235715491
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASPROMONTI
FirstName: MARISA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 270 FARMINGTON AVE STE 328
Address2:  
City: FARMINGTON
State: CT
PostalCode: 060321909
CountryCode: US
TelephoneNumber: 8668876864
FaxNumber: 8668876864
Practice Location
Address1: 800 CONNECTICUT BLVD FL 4
Address2:  
City: EAST HARTFORD
State: CT
PostalCode: 061083239
CountryCode: US
TelephoneNumber: 8605695900
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/18/2021
LastUpdateDate: 03/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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