Provider Demographics
NPI:1174330211
Name:MARICA, OWEN
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:MARICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OLD CART RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438-1271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 DURHAM RD STE 19
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2657
Practice Address - Country:US
Practice Address - Phone:860-876-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health