Mari Jo Macinnis, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

000917 Issued in CT

Practice address

163 Boston Post Road Suite 384
Waterford, CT 06385

Phone

(860) 444-8774

Fax

(860) 444-8776

NPI assigned

Nov 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• United Community and Family Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Norwich, CT
  • NPI 1467482539
  Medicare reassignment NPD
• United Community and Family Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Norwich, CT
  • NPI 1558366757

  Marriage & Family Therapist

  NPD

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083787329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 BOSTON POST ROAD SUITE 384",
            "address_2": "PO BOX 328",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-444-8774",
            "fax_number": "860-444-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 BOSTON POST ROAD SUITE 384",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-444-8774",
            "fax_number": "860-444-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACINNIS",
        "first_name": "MARI JO",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "000917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "410000917CT09",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lundfelt
• Luxottica of America Inc.
• Luxottica Retail North America Inc
• Martha Ma, LAC, M.S.
• Sin Ying Ma
• John Ross Mackinnon, PH.D.
• Melissa T Mahar, MS,RPH
• Noha Maklad
• Frank William Maletz, M.D.
• Brian G Mann, OD

• Marriage & Family Therapist in Waterford, CT
• Providers in Waterford, CT by specialty
• Marriage & Family Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.