Provider Demographics
NPI:1164872586
Name:SABOLCIK, GEORGE MONTY SR (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MONTY
Last Name:SABOLCIK
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-0610
Mailing Address - Country:US
Mailing Address - Phone:860-567-9423
Mailing Address - Fax:860-567-8127
Practice Address - Street 1:550 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2405
Practice Address - Country:US
Practice Address - Phone:860-567-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007523104100000X, 1041C0700X
CT67699736901041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool