Healthcare Provider Details

I. General information

NPI: 1992727036
Provider Name (Legal Business Name): ELINOR G COLOCCIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN G VENNOLA PSY.D.

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CANAL RD
GRANBY CT
06035-2220
US

IV. Provider business mailing address

84 CANAL RD
GRANBY CT
06035-2220
US

V. Phone/Fax

Practice location:
  • Phone: 860-904-3089
  • Fax:
Mailing address:
  • Phone: 860-904-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001502
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002853
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2853
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: