Organization
FORT HILL COUNSELORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JOSEPH MACIOLEK PH.D. (LICENSED PSYCHOLOGIST)
(860) 415-4551
Entity
Organization
Contact information
Practice address
1 FORT HILL RD, GROTON, CT 06340-4799
(860) 415-4551
(860) 415-4554
Mailing address
1 FORT HILL RD, GROTON, CT 06340-4799
(860) 415-4551
(860) 415-4554
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001048
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004057436
—
CT
01
—
060001048CT06
ANTHEM BC/BS
CT
01
—
186856
MHN/TRICARE
CT
Enumeration date
08/14/2008
Last updated
11/20/2015
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