Provider Demographics
NPI:1497130140
Name:WARHAFTIG, MARAH
Entity type:Individual
Prefix:MRS
First Name:MARAH
Middle Name:
Last Name:WARHAFTIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PROSPECT AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4252
Mailing Address - Country:US
Mailing Address - Phone:860-833-1403
Mailing Address - Fax:
Practice Address - Street 1:645 PROSPECT AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4252
Practice Address - Country:US
Practice Address - Phone:860-833-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty