Individual
MICHAEL JOHN FORMICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
616 GOLD STAR HWY, GROTON, CT 06340-6221
(860) 449-0200
(860) 449-1954
Mailing address
32 SEA CREST AVE, NIANTIC, CT 06357-3808
(203) 912-7218
(860) 449-1954
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
000869
CT
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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