MEDICARE: PODOLSKI PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1447849260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODOLSKI PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	44 FIELDSTONE DR
Second Line	:
City	:	SOUTH GLASTONBURY
State	:	CT
Zip	:	06073-3718
Country	:	US
Telephone Number	:	860-707-4880
Fax Number	:	860-955-4804

Provider Business Practice Location Address
First Line	:	433 S MAIN ST STE 327
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2816
Country	:	US
Telephone Number	:	860-410-4007
Fax Number	:	860-955-4804

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. MARIELA PODOLSKI
Credential	:	MD
Telephone Number	:	860-410-4007

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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