Provider Demographics
NPI:1891851739
Name:MOZZICATO, SEBASTIAN (MD)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:MOZZICATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:DUTTON HOME SILVER ST PO BOX 351
Mailing Address - Street 2:RIVER VALLEY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-5358
Mailing Address - Fax:860-262-5356
Practice Address - Street 1:DUTTON HOME SILVER ST
Practice Address - Street 2:RIVER VALLEY SERVICES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:08457
Practice Address - Country:US
Practice Address - Phone:860-262-5358
Practice Address - Fax:860-262-5356
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0152102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B39496Medicare UPIN