Individual provider Active NPI

Judith Smith

  • Mental Health Counselor
  • Manchester, CT
National Provider Identifier
1063755767
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
587 Middle Tpke E
Manchester, CT 06040-3731
Phone
(860) 646-3888
Fax
(860) 645-4132
NPI assigned
Apr 1, 2013
Last updated
Apr 1, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

587 Middle Tpke E
Manchester, CT 06040-3731

Mailing address

587 Middle Tpke E
Manchester, CT 06040-3731
Phone (860) 646-3888

Other names 1

  • Judith Marohl Former name

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
I20240712001675 CT Practitioner - Marriage and Family Therapist 8628513785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Change Counseling LLCGroup PAC ID 9234564956, 6 clinicians

Practice addresses (Care Compare)

6 Ledgebrook Dr
Suite C
Mansfield Center, CT 06250-1644
Phone (860) 833-2657

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Change Counseling, LLC CurrentSince Jul 1, 2024 Accepting new patients
Community Health Resources, Inc. Past Accepting new patients

Locations

6 Ledgebrook Dr
Ste C
Mansfield Center, CT 06250
Phone (860) 833-2657

Organizations & group practices 2

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": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1063755767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JUDITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "MAROHL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.