| Maritza Bourassa, Lcsw | |
|
481 Gold Star Hwy Ste 301 Groton CT 06340-6702 | |
| (860) 448-9755 | |
| (860) 405-1910 |
| Full Name | Maritza Bourassa, Lcsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 481 Gold Star Hwy Ste 301, Groton, Connecticut |
| Authorized Official Name and Position | Maritza Bourassa (MEMBER) |
| Authorized Official Contact | 8604489755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maritza Bourassa, Lcsw 481 Gold Star Hwy Ste 301 Groton CT 06340-6702 Ph: (860) 448-9755 | Maritza Bourassa, Lcsw 481 Gold Star Hwy Ste 301 Groton CT 06340-6702 Ph: (860) 448-9755 |
| NPI Number | 1356688642 |
|---|---|
| Provider Enumeration Date | 01/07/2013 |
| Last Update Date | 01/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356688642 | NPI | - | NPPES |
| 005019 | Other | CT | ST. OF CT. LCSW NUMBER |
| 004259059 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 005019 (Connecticut) | Primary |
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