Psychological Services of Kensington, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

002808 Issued in CT

Legal business name

PSYCHOLOGICAL SERVICES OF KENSINGTON, LLC

Practice address

1097 Farmington Ave
Berlin, CT 06037-2241

Phone

(860) 836-7553

NPI assigned

Feb 10, 2018

Last updated

Feb 10, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Henderson-Kjellen, PSY.D.NPI 1417044165

Title

Owner

Phone

(860) 836-7553

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 3

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.

• Kimberly Henderson-Kjellen, PSYD

  • Clinical Psychologist
  • Berlin, CT
  • NPI 1417044165
  Medicare reassignment Authorized official
• Monica Phyllis Linder, LCSW

  • Clinical Social Worker
  • Beaverton, OR
  • NPI 1275006546
  NPD
• Walter E. Henderson Jr., D.C.

  • Chiropractor
  • Berlin, CT
  • NPI 1801945548
  NPD (past)

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

{
    "created_epoch": "1518220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518220800000",
    "number": "1073012597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1097 FARMINGTON AVE",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060372241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1097 FARMINGTON AVE",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060372241",
            "telephone_number": "860-836-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICES OF KENSINGTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-10",
        "last_updated": "2018-02-10",
        "status": "A",
        "authorized_official_last_name": "HENDERSON-KJELLEN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-836-7553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "002808",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CT",
            "license": "002808",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Berlin, CT
• Providers in Berlin, CT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2018; 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.