1326596412 NPI number — MALWINA DORAZIO LMFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326596412 NPI number — MALWINA DORAZIO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORAZIO
Provider First Name:
MALWINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRZADKO
Provider Other First Name:
MALWINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326596412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX: 370606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-276-3000
Provider Business Mailing Address Fax Number:
860-276-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 CAPITAL BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
475-837-0514
Provider Business Practice Location Address Fax Number:
860-276-3002
Provider Enumeration Date:
09/17/2016

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:  001850 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , 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: 008062893 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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