NPIMap

Organization Active NPI

Embodying Redemption

  • Marriage & Family Therapist
  • New Haven, CT
National Provider Identifier
1093058257
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1470 Issued in CT
Legal business name
EMBODYING REDEMPTION
Practice address
495 Orange St
New Haven, CT 06511-3809
Phone
(206) 321-8555
NPI assigned
Apr 5, 2013
Last updated
Oct 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Authorized official

Name
Ms. Laura Wallace, LMFTNPI 1659515013
Title
Owner
Phone
(206) 321-8555

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1470 CT Primary

Addresses

Primary practice location

495 Orange St
New Haven, CT 06511-3809

Mailing address

872 State St Apt 3D
New Haven, CT 06511-7310
Phone (206) 321-8555

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1365120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1093058257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 STATE ST APT 3D",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065117310",
            "telephone_number": "206-321-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 ORANGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113809",
            "telephone_number": "206-321-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODYING REDEMPTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-05",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-321-8555",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "1470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; 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.