Thomas Joseph Maciolek, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001048 Issued in CT

Practice address

616 Gold Star Hwy
Groton, CT 06340-6221

Phone

(860) 449-0200

Fax

(860) 449-1954

NPI assigned

Sep 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medoptions Behavioral Health Assoc, LLC

  • Nurse Practitioner
  • Old Saybrook, CT
  • NPI 1588604060

  Clinical

  NPD (past)

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821198508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 GOLD STAR HWY",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406221",
            "telephone_number": "860-449-0200",
            "fax_number": "860-449-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 GOLD STAR HWY",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406221",
            "telephone_number": "860-449-0200",
            "fax_number": "860-449-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACIOLEK",
        "first_name": "THOMAS",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manuel Lozano, IDC
• Emberleigh Lyn Luce, LMFT
• Christie Lee Lunny, COTA/L
• Luxottica of America Inc. (Pearle #C439)
• Lydia P Perry LPC Ladc
• Jennifer Lee Mackey, D.M.D.
• Crystal Mackinnon, LCSW
• Theologos Ted Malahias, D.D.S
• Christine M Malcom, P.T.
• John Anthony Maldonado-Rivera

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.