Basic Information
| Provider Information | |||||||||
| NPI: | 1811230063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINELLI | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033000 | ||||||||
| FaxNumber: | 2035033066 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 THOMPSON ST STE A103 | ||||||||
| Address2: | |||||||||
| City: | EAST HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065135701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036911685 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2013 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 10304 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.