NPIMap

Organization Active NPI

Psychological Health & Development Associates, LLC

  • Psychologist
  • Wethersfield, CT
National Provider Identifier
1144519968
Registry record updated Oct 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
002726 Issued in CT
Legal business name
PSYCHOLOGICAL HEALTH & DEVELOPMENT ASSOCIATES, LLC
Practice address
433 Silas Deane Hwy
Wethersfield, CT 06109-2123
Phone
(860) 338-5911
NPI assigned
Apr 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2015

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

Authorized official

Name
Dr. Janine Elizabeth Swanson, PSYDNPI 1558453761
Title
Owner
Phone
(860) 338-5911

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
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 002726 CT Primary

Addresses

Primary practice location

433 Silas Deane Hwy
Wethersfield, CT 06109-2123

Mailing address

PO Box 122
Glastonbury, CT 06033-0122
Phone (860) 338-5911

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160122000307 CT Part B Supplier - Clinic/Group Practice 6103129333 Receives reassigned benefits from 6 practitioners
Practice locations: Wethersfield, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445644800000",
    "number": "1144519968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060330122",
            "telephone_number": "860-338-5911",
            "fax_number": "860-633-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092123",
            "telephone_number": "860-338-5911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL HEALTH & DEVELOPMENT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-01",
        "last_updated": "2015-10-24",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "JANINE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-338-5911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CT",
            "license": "002726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wethersfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2015; 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.