Healthcare Provider Details

I. General information

NPI: 1447849260
Provider Name (Legal Business Name): PODOLSKI PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S MAIN ST STE 327
WEST HARTFORD CT
06110-2816
US

IV. Provider business mailing address

44 FIELDSTONE DR
SOUTH GLASTONBURY CT
06073-3718
US

V. Phone/Fax

Practice location:
  • Phone: 860-410-4007
  • Fax: 860-955-4804
Mailing address:
  • Phone: 860-707-4880
  • Fax: 860-955-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIELA PODOLSKI
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 860-410-4007