Southern CT Christian Network

Primary specialty

Forensic Psychiatry PhysicianTaxonomy code 2084F0202X

License

039301 Issued in CT

Legal business name

SOUTHERN CT CHRISTIAN NETWORK

Practice address

145 Durham Rd
Mailbox 7
Madison, CT 06443-2674

Phone

(203) 318-0070

Fax

(206) 339-8205

NPI assigned

Mar 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ulari Dike

Title

Office Manager

Phone

(203) 318-0700

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• Shoreline Christian Counseling Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• R. Timothy Kearney, PHD

  • Clinical Psychologist
  • Middletown, CT
  • NPI 1144226390
  NPD (past)
• Nancy Shin-Yii Jung, LCSW

  • Clinical Social Worker
  • Bentonville, AR
  • NPI 1174667596
  NPD (past)
• Amal B. Tanagho, M.D.

  • Specialist
  • Huntington Beach, CA
  • NPI 1154538023
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1033239249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 DURHAM RD",
            "address_2": "MAILBOX 7",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432674",
            "telephone_number": "203-318-0070",
            "fax_number": "206-339-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 DURHAM RD",
            "address_2": "MAILBOX 7",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432674",
            "telephone_number": "203-318-0070",
            "fax_number": "206-339-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CT CHRISTIAN NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "DIKE",
        "authorized_official_first_name": "ULARI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-318-0700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001460",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "002876",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004809",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "CT",
            "license": "039301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004257269",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004257277",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET-MHN",
            "identifier": "307875",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004257532",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoreline Christian Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marisa Kelsey Sierra, LMFT
• Joseph M Slater, P.A.
• Adrienne G Smaller, PH.D.
• Keiren Donovan Smith, M.D.
• Allison E. Solecki, OTR
• Madison Sparago
• Speech of Madison, LLC
• Claire Abigail Spinks, COTA
• Erin S. Springhorn, M.D.
• Staywell Stress Management LLC

• Forensic Psychiatry Physician in Madison, CT
• Providers in Madison, CT by specialty
• Forensic Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.