1649336553 NPI number — MRS. MINDY M PACILEO

Table of content: MRS. MINDY M PACILEO (NPI 1649336553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649336553 NPI number — MRS. MINDY M PACILEO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACILEO
Provider First Name:
MINDY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOMBROWSKI
Provider Other First Name:
MINDY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649336553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 328
Provider Second Line Business Mailing Address:
163 BOSTON POST RD SUITES 3 4
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-444-8774
Provider Business Mailing Address Fax Number:
860-444-8776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SUITES 3 4 CONNECTIONS COUNSELING WELLNESS CTR LLC
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-444-8774
Provider Business Practice Location Address Fax Number:
860-444-8776
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  001215 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 269925 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240001215CT04 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 458669 . This is a "VO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7361335 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3676137 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".