Provider Demographics
NPI:1326596412
Name:DORAZIO, MALWINA (LMFT)
Entity Type:Individual
Prefix:
First Name:MALWINA
Middle Name:
Last Name:DORAZIO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MALWINA
Other - Middle Name:
Other - Last Name:GRZADKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX: 370606
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137
Mailing Address - Country:US
Mailing Address - Phone:860-276-3000
Mailing Address - Fax:860-276-3002
Practice Address - Street 1:175 CAPITAL BOULEVARD
Practice Address - Street 2:SUITE 403
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:475-837-0514
Practice Address - Fax:860-276-3002
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001850101YM0800X
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008062893Medicaid