Individual provider Active NPI

Alyssa Lee Patenaude, MS, LMFT

  • Marriage & Family Therapist
  • Glastonbury, CT
National Provider Identifier
1033648514
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
3166 Issued in CT
Practice address
148 Eastern Blvd Ste 200
Glastonbury, CT 06033-4321
Phone
(860) 815-8991
NPI assigned
Jun 8, 2017
Last updated
Jul 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 3166 CT Primary

Addresses

Primary practice location

148 Eastern Blvd Ste 200
Glastonbury, CT 06033-4321

Mailing address

148 Eastern Blvd Ste 200
Glastonbury, CT 06033-4321
Phone (860) 815-8991

Other practice location 1

74 East St
Plainville, CT 06062-2367
Phone (860) 793-4799

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240908000120 CT Practitioner - Marriage and Family Therapist 5395285118 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3166CTMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Union Cognitive Care, PC CurrentSince Sep 3, 2024 Accepting new patients

Locations

148 Eastern Blvd
Ste 200
Glastonbury, CT 06033
Phone (860) 269-3584

98 East Ave
Ste 3
Norwalk, CT 06851
Phone (203) 580-6660

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1033648514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 EASTERN BLVD STE 200",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334321",
            "telephone_number": "860-815-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 EASTERN BLVD STE 200",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334321",
            "telephone_number": "860-815-8991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 East St",
            "address_purpose": "LOCATION",
            "city": "Plainville",
            "state": "CT",
            "postal_code": "060622367",
            "country_code": "US",
            "telephone_number": "860-793-4799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATENAUDE",
        "first_name": "ALYSSA",
        "middle_name": "LEE",
        "credential": "MS, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "3166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

Verify at the official NPI Registry.