NPIMap

Organization Active NPI

The Healthy Mind Psychiatric Services PC

  • Psychiatry Physician
  • Middlebury, CT
National Provider Identifier
1063785814
Registry record updated Nov 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
039250 Issued in CT
Legal business name
THE HEALTHY MIND PSYCHIATRIC SERVICES PC
Practice address
900 Straits Tpke
Suite D
Middlebury, CT 06762-2800
Phone
(203) 270-5575
Fax
(203) 883-0365
NPI assigned
Feb 9, 2012
Last updated
Nov 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2014

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

Authorized official

Name
Shah Nawaz, MDNPI 1831128305
Title
Medical Director
Phone
(203) 270-5575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 039250 CT
Counselor 101Y00000X 039250 CT
Mental Health Counselor 101YM0800X 039250 CT
Professional Counselor 101YP2500X 039250 CT
Social Worker 104100000X 039250 CT
Clinical Social Worker 1041C0700X 039250 CT
Psychiatry Physician 2084P0800X 039250 CT Primary

Addresses

Primary practice location

900 Straits Tpke
Suite D
Middlebury, CT 06762-2800

Mailing address

900 Straits Tpke
Suite D
Middlebury, CT 06762-2800
Phone (203) 270-5575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120319000396 CT Part B Supplier - Clinic/Group Practice 4082874672 Receives reassigned benefits from 10 practitioners
Practice locations: Middlebury, CT; Waterbury, CT

National Provider Directory

National Provider Directory

Locations

900 Straits Tpke
Ste D
Middlebury, CT 06762
Phone (203) 270-5575

60 Westwood Ave
Ste 230
Waterbury, CT 06708
Phone (203) 753-2800

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1063785814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 STRAITS TPKE",
            "address_2": "SUITE D",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622800",
            "telephone_number": "203-270-5575",
            "fax_number": "203-883-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 STRAITS TPKE",
            "address_2": "SUITE D",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622800",
            "telephone_number": "203-270-5575",
            "fax_number": "203-883-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HEALTHY MIND PSYCHIATRIC SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "NAWAZ",
        "authorized_official_first_name": "SHAH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-270-5575",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "039250",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "039250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.