Provider Demographics
NPI:1689127482
Name:GIORGIO, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GIORGIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BATCHELDER RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3028
Mailing Address - Country:US
Mailing Address - Phone:860-841-2388
Mailing Address - Fax:855-386-7000
Practice Address - Street 1:17 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1826
Practice Address - Country:US
Practice Address - Phone:860-295-4103
Practice Address - Fax:855-386-7000
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist