| Organization Name: | ELLEN COLOCCIA, PSYD, LLC |
| NPI Number: | 1003238072 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELLEN G COLOCCIA (OWNER) |
| Mailing Address: | 148 Eastern Blvd Suite 302 Glastonbury |
| State: | CT US |
| Postal Code: | 060334321 |
| Phone Number: | 8606332810 |
| Fax Number: | 8606332865 |
| NPI Enumeration Date: | 01/10/2014 |
| NPI Last Update Date: | 01/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2853 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |