Fort Hill Counselors LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001048 Issued in CT

Legal business name

FORT HILL COUNSELORS LLC

Practice address

1 Fort Hill Rd
Groton, CT 06340-4799

Phone

(860) 415-4551

Fax

(860) 415-4554

NPI assigned

Aug 14, 2008

Last updated

Nov 20, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas Joseph Maciolek, PH.D.

Title

Licensed Psychologist

Phone

(860) 415-4551

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447977600000",
    "number": "1740436344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORT HILL RD",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404799",
            "telephone_number": "860-415-4551",
            "fax_number": "860-415-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FORT HILL RD",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404799",
            "telephone_number": "860-415-4551",
            "fax_number": "860-415-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT HILL COUNSELORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-14",
        "last_updated": "2015-11-20",
        "status": "A",
        "authorized_official_last_name": "MACIOLEK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "860-415-4551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "060001048CT06",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004057436",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN/TRICARE",
            "identifier": "186856",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Dean Fitzpatrick, DO
• Christian L Flowers
• Brian Russell Flynn, SUBMARINE IDC
• Michael John Formica, LPC
• Mauricio Foronda, SUB IDC
• Fort Hill Pharmacy Inc
• Fort Hill Pharmacy Inc
• Fort Hill Pharmacy, Inc. (Fort Hill Medical)
• Mason Cleary Ditthardt Fortuno, DMD
• Brian Charles Fournier

• Clinical Psychologist in Groton, CT
• Providers in Groton, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.