Provider Demographics
NPI:1861059370
Name:LABRECQUE-GRENIER, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LABRECQUE-GRENIER
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 1:124 VAN CEDARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1626
Mailing Address - Country:US
Mailing Address - Phone:860-823-9323
Mailing Address - Fax:
Practice Address - Street 1:101 WATER ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5730
Practice Address - Country:US
Practice Address - Phone:860-425-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor