Individual
THERESA ROSE MANOLITSIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 404-6360
Mailing address
170 PONDVIEW LN, BRISTOL, CT 06010-3085
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XGC0246M50200
ANTHEM BLUE CROSS/BLUE SHIELD
CT
Enumeration date
07/07/2017
Last updated
07/07/2023
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