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General NPI Number Information
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NPI Number | 1023201589
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Entity Type | Individual
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Provider Name | MARIELA PODOLSKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 433 S MAIN ST STE 327
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2816
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Country | US
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Telephone | 860-410-4007
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Fax | 860-955-4804
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Provider Business Mailing Address
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Address Line | 44 FIELDSTONE DR
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City | SOUTH GLASTONBURY
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State | CT
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Zip | 06073-3718
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Country | US
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Telephone | 860-707-4880
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Fax | 860-955-4804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 266869
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 050622
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 8279
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 266869
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 050622
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License Number State | CT
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