Provider Demographics
NPI:1447849260
Name:PODOLSKI PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PODOLSKI PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-410-4007
Mailing Address - Street 1:44 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3718
Mailing Address - Country:US
Mailing Address - Phone:860-707-4880
Mailing Address - Fax:860-955-4804
Practice Address - Street 1:433 S MAIN ST STE 327
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2816
Practice Address - Country:US
Practice Address - Phone:860-410-4007
Practice Address - Fax:860-955-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health