| Ellen Coloccia, Psy D Llc | |
|
84 Canal Rd Granby CT 06035-2220 | |
| (860) 904-3089 | |
| Not Available |
| Full Name | Ellen Coloccia, Psy D Llc |
|---|---|
| Speciality | Psychologist |
| Location | 84 Canal Rd, Granby, Connecticut |
| Authorized Official Name and Position | Ellen G Coloccia (OWNER) |
| Authorized Official Contact | 8606332810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen Coloccia, Psy D Llc 84 Canal Rd Granby CT 06035-2220 Ph: (860) 904-3089 | Ellen Coloccia, Psy D Llc 84 Canal Rd Granby CT 06035-2220 Ph: (860) 904-3089 |
| NPI Number | 1003238072 |
|---|---|
| Provider Enumeration Date | 01/10/2014 |
| Last Update Date | 11/16/2022 |
| Certification Date | 11/16/2022 |
| Medicare PECOS PAC ID | 3577931153 |
|---|---|
| Medicare Enrollment ID | O20221202000274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003238072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2853 (Connecticut) | Primary |
| Provider Name | Elinor G Coloccia |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992727036 PECOS PAC ID: 3870982168 Enrollment ID: I20211108000213 |
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