Provider Demographics
NPI:1649336553
Name:PACILEO, MINDY M
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:M
Last Name:PACILEO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:M
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:163 BOSTON POST RD SUITES 3 4
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-444-8774
Mailing Address - Fax:860-444-8776
Practice Address - Street 1:163 BOSTON POST RD
Practice Address - Street 2:SUITES 3 4 CONNECTIONS COUNSELING WELLNESS CTR LLC
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-444-8774
Practice Address - Fax:860-444-8776
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
269925OtherMHN
240001215CT04OtherANTHEM BCBS
458669OtherVO
7361335OtherAETNA
P3676137OtherOXFORD