NPIMap

Organization Active NPI

Connecticut Geriatric Psychological Services, PC

  • Adult Development & Aging Psychologist
  • Port Chester, NY
National Provider Identifier
1124340203
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Development & Aging PsychologistTaxonomy code 103TA0700X
License
2657 Issued in CT
Legal business name
CONNECTICUT GERIATRIC PSYCHOLOGICAL SERVICES, PC
Practice address
112 Betsy Brown Rd
Port Chester, NY 10573-2231
Phone
(914) 937-6174
Fax
(914) 937-6174
NPI assigned
Feb 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Authorized official

Name
Dr. Timothy W. Welles, ED.D.
Title
President
Phone
(914) 937-6174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TA0700X 2657 CT Primary

Addresses

Primary practice location

112 Betsy Brown Rd
Port Chester, NY 10573-2231

Mailing address

112 Betsy Brown Rd
Port Chester, NY 10573-2231
Phone (914) 937-6174

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1124340203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 BETSY BROWN RD",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105732231",
            "telephone_number": "914-937-6174",
            "fax_number": "914-937-6174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 BETSY BROWN RD",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105732231",
            "telephone_number": "914-937-6174",
            "fax_number": "914-937-6174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT GERIATRIC PSYCHOLOGICAL SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "WELLES",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-937-6174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CT",
            "license": "2657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Chester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.