Bourassa, Maritza
Bourassa, Maritza is an sole proprietor health care provider with primary practice located at 481 Gold Star Hwy Suite 301, Groton CT 06340-6224. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bourassa, Maritza can be contacted via phone (860) 448-9755.Contact Information
Primary practice address
481 Gold Star Hwy Suite 301
Groton CT 06340-6224
Phone: (860) 448-9755
Fax: (860) 464-2298
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 005019 | Connecticut |
Profile Details
| NPI number | 1326055062 |
|---|---|
| LBN Legal business name | Bourassa, Maritza |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 2nd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326055062 | NPPES |
| Connecticut | MEDICAID | 004236338 | |
| Connecticut | Other | 005019 | |
| Connecticut | MEDICAID | 004259059 |
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