Provider Demographics
NPI:1437701497
Name:MARTELL, DENYCE MARIE (MS-MFT)
Entity type:Individual
Prefix:
First Name:DENYCE
Middle Name:MARIE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MS-MFT
Other - Prefix:
Other - First Name:DENYCE
Other - Middle Name:MARIE
Other - Last Name:SHINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-MFT
Mailing Address - Street 1:19 JULIAN DR
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8002
Mailing Address - Country:US
Mailing Address - Phone:860-337-9238
Mailing Address - Fax:860-300-4267
Practice Address - Street 1:116 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4112
Practice Address - Country:US
Practice Address - Phone:860-337-9238
Practice Address - Fax:860-300-4267
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist