NPIMap

Organization Active NPI

CCSN Behavioral Health, LLC

  • Intellectual & Developmental Disabilities Psychologist
  • Glastonbury, CT
National Provider Identifier
1144767286
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
License
001779 Issued in CT
Legal business name
CCSN BEHAVIORAL HEALTH, LLC
Practice address
2300 Main St
Glastonbury, CT 06033-2218
Phone
(860) 430-1762
Fax
(860) 430-1767
NPI assigned
Jan 27, 2017
Organization subpart
Yes
Parent organization
THE CENTER FOR CHILDREN WITH SPECIAL NEEDS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Authorized official

Name
Dr. Michael D Powers, PSYD
Title
Executive Director
Phone
(860) 430-1762

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 001779 CT
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X 001779 CT Primary

Addresses

Primary practice location

2300 Main St
Glastonbury, CT 06033-2218

Mailing address

2300 Main St
Glastonbury, CT 06033-2218
Phone (860) 430-1762

National Provider Directory

National Provider Directory
Part of
The Center for Children With Special Needs LLC

Locations

270 Farmington Ave
Ste 264
Farmington, CT 06032
Phone (860) 430-1762

2213 Main St
Glastonbury, CT 06033
Phone (860) 430-1762

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1144767286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 MAIN ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332218",
            "telephone_number": "860-430-1762",
            "fax_number": "860-430-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 MAIN ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332218",
            "telephone_number": "860-430-1762",
            "fax_number": "860-430-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCSN BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CENTER FOR CHILDREN WITH SPECIAL NEEDS, LLC",
        "enumeration_date": "2017-01-27",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "860-430-1762",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "CT",
            "license": "001779",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CT",
            "license": "001779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; 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.