Provider Demographics
NPI:1861752362
Name:TOLOCZKO, MITCHELL PETER JR
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:PETER
Last Name:TOLOCZKO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 APPLE TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1610
Mailing Address - Country:US
Mailing Address - Phone:617-571-3173
Mailing Address - Fax:508-435-4720
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-485-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health