Michael John Formica, LPC

NPI #1174688311 in Groton, Connecticut

Provider Information

NPI Number: 1174688311
Entity Type: Individual
Name: Michael John Formica, LPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Credential: LPC
Enumeration Date: Dec 27, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 616 GOLD STAR HWY
City: Groton
State: Connecticut
ZIP Code: 06340-6221
Phone: (860) 449-0200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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