Provider Demographics
NPI:1992727036
Name:COLOCCIA, ELINOR G (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELINOR
Middle Name:G
Last Name:COLOCCIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:G
Other - Last Name:VENNOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:84 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2220
Mailing Address - Country:US
Mailing Address - Phone:860-904-3089
Mailing Address - Fax:
Practice Address - Street 1:599 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2356
Practice Address - Country:US
Practice Address - Phone:860-837-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2853103TC0700X
CT002853103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical