NPIMap

Organization Active NPI

Connections Counseling Center, LLC

  • Psychiatry Physician
  • Waterford, CT
National Provider Identifier
1114069663
Registry record updated Nov 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
021511 Issued in CT
Legal business name
CONNECTIONS COUNSELING CENTER, LLC
Practice address
163 Boston Post Rd
Waterford, CT 06385-0328
Phone
(860) 444-8774
Fax
(860) 444-8776
NPI assigned
Feb 13, 2007
Last updated
Nov 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2009

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

Authorized official

Name
Miss Sue Ellen Daniels, LMFTNPI 1780785162
Title
Owner
Phone
(860) 444-8774

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X 021511 CT Primary

Addresses

Primary practice location

163 Boston Post Rd
Waterford, CT 06385-0328

Mailing address

163 Boston Post Rd
Waterford, CT 06385-0328
Phone (860) 444-8774

Other identifiers 3

IdentifierTypeStateIssuer
004256089MedicaidCT
004256120MedicaidCT
004256104MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090928000718 CT Part B Supplier - Clinic/Group Practice 9032265368 Receives reassigned benefits from 2 practitioners
Practice locations: New London, CT

National Provider Directory

National Provider Directory

Locations

154 Hempstead St
#2
New London, CT 06320
Phone (860) 444-8774

163 Boston Post Rd
Waterford, CT 06385
Phone (860) 444-8774

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259193600000",
    "number": "1114069663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 BOSTON POST RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063850328",
            "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 RD",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063850328",
            "telephone_number": "860-444-8774",
            "fax_number": "860-444-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTIONS COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2009-11-26",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "SUE ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-444-8774",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "021511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004256089",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004256120",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004256104",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2009; 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.