Provider Demographics
NPI:1013140656
Name:MODZELESKY, THOMAS J (BA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MODZELESKY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GRISWOLD ST
Mailing Address - Street 2:HOSPITAL OF CENTRAL CONNECTICUT
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2008
Mailing Address - Country:US
Mailing Address - Phone:860-224-5267
Mailing Address - Fax:860-224-5752
Practice Address - Street 1:88 SOMERWYND LN
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-1229
Practice Address - Country:US
Practice Address - Phone:860-668-0512
Practice Address - Fax:860-668-2838
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor