Provider Demographics
NPI:1720119506
Name:POGLITSCH, HOLLY (MS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:POGLITSCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 OLD SHERMAN HILL RD.
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798
Mailing Address - Country:US
Mailing Address - Phone:203-518-3088
Mailing Address - Fax:203-266-4150
Practice Address - Street 1:385 MAIN STREET SOUTH
Practice Address - Street 2:UNION SQUARE SUITE 215 2ND FL.
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-518-3088
Practice Address - Fax:203-266-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional