Southwest Trauma Informed Integrated Care LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTHWEST TRAUMA INFORMED INTEGRATED CARE LLC

Practice address

125 Shanley St
Stratford, CT 06615-6944

Phone

(475) 298-3887

NPI assigned

Jun 29, 2022

Organization subpart

No

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

Authorized official

Name

Felisha Mack, DNP, APRNNPI 1851805832

Title

Pmhnp-BC, FNP-BC

Phone

(475) 298-3887

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

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

• Felisha Mack

  • Family Nurse Practitioner
  • Bridgeport, CT
  • NPI 1851805832
  NPD Authorized official

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

{
    "created_epoch": "1656460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1043942899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 SHANLEY ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066156944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SHANLEY ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066156944",
            "telephone_number": "475-298-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST TRAUMA INFORMED INTEGRATED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "FELISHA",
        "authorized_official_title_or_position": "PMHNP-BC, FNP-BC",
        "authorized_official_telephone_number": "475-298-3887",
        "authorized_official_credential": "DNP, APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Other",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Other",
            "address_1": "125 shanley street",
            "city": "Stratford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "06615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Stratford, CT
• Providers in Stratford, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.