Individual provider Active NPI

Ryan Tacy

  • Counselor
  • Willimantic, CT
National Provider Identifier
1053870212
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
1491 Main St
Willimantic, CT 06226-1914
Phone
(860) 456-3215
Fax
(860) 456-3351
NPI assigned
Mar 18, 2019
Last updated
Mar 18, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary

Addresses

Primary practice location

1491 Main St
Willimantic, CT 06226-1914

Mailing address

995 Day Hill Rd
Windsor, CT 06095-1722
Phone (860) 697-3351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1053870212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 DAY HILL RD",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951722",
            "telephone_number": "860-697-3351",
            "fax_number": "860-731-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1491 MAIN ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261914",
            "telephone_number": "860-456-3215",
            "fax_number": "860-456-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACY",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.