NPIMap

Organization Active NPI

Soul Friends, Inc

  • Community/Behavioral Health Agency
  • Wallingford, CT
National Provider Identifier
1154499804
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUL FRIENDS, INC
Practice address
300 Church St
Suite 105
Wallingford, CT 06492-2253
Phone
(203) 679-0849
NPI assigned
Dec 1, 2006
Last updated
Jan 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

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

Authorized official

Name
Ms. M. Kathryn Nicoll, MSW
Title
President
Phone
(203) 679-0849

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 002617 CT
Community/Behavioral Health Agency 251S00000X CT Primary

Addresses

Primary practice location

300 Church St
Suite 105
Wallingford, CT 06492-2253

Mailing address

300 Church St
Suite 105
Wallingford, CT 06492-2253
Phone (203) 679-0849

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060302000694 CT Part B Supplier - Clinic/Group Practice 9133135916 Receives reassigned benefits from 1 practitioner
Practice locations: Wallingford, CT

National Provider Directory

National Provider Directory

Locations

401 Center St
Wallingford, CT 06492
Phone (203) 237-8988

300 Church St
Ste 105
Yalesville, CT 06492
Phone (203) 679-0849

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1154499804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST",
            "address_2": "SUITE 105",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "203-679-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST",
            "address_2": "SUITE 105",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "203-679-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL FRIENDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "NICOLL",
        "authorized_official_first_name": "M. KATHRYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-679-0849",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "002617",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.