| Fort Hill Counselors Llc | |
|
1 Fort Hill Rd Groton CT 06340-4799 | |
| (860) 415-4551 | |
| (860) 415-4554 |
| Full Name | Fort Hill Counselors Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1 Fort Hill Rd, Groton, Connecticut |
| Authorized Official Name and Position | Thomas Joseph Maciolek (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 8604154551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Hill Counselors Llc 1 Fort Hill Rd Groton CT 06340-4799 Ph: (860) 415-4551 | Fort Hill Counselors Llc 1 Fort Hill Rd Groton CT 06340-4799 Ph: (860) 415-4551 |
| NPI Number | 1740436344 |
|---|---|
| Provider Enumeration Date | 08/14/2008 |
| Last Update Date | 11/20/2015 |
| Medicare PECOS PAC ID | 5890841373 |
|---|---|
| Medicare Enrollment ID | O20090924000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740436344 | NPI | - | NPPES |
| 004057436 | Medicaid | CT | |
| 060001048CT06 | Other | CT | ANTHEM BC/BS |
| 186856 | Other | CT | MHN/TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 001048 (Connecticut) | Primary |
| Provider Name | Thomas J Maciolek |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821198508 PECOS PAC ID: 6507905114 Enrollment ID: I20091120000007 |
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