Provider Demographics
NPI:1053985697
Name:FRATONI, MARISSA (BA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:FRATONI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEWETT CITY
Mailing Address - State:CT
Mailing Address - Zip Code:06351-2110
Mailing Address - Country:US
Mailing Address - Phone:860-376-7040
Mailing Address - Fax:
Practice Address - Street 1:226 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-2110
Practice Address - Country:US
Practice Address - Phone:860-376-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist