NPIMap

Organization Active NPI

Optum Behavioral Care of Connecticut, P.C.

  • Clinical Psychologist
  • Beverly, MA
National Provider Identifier
1164292512
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Practice address
100 Cummings Ctr Ste 456J
Beverly, MA 01915-6132
Phone
(978) 296-3460
NPI assigned
Jan 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Amanda Stacey Bronson
Title
Ceo
Phone
(978) 222-3121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

100 Cummings Ctr Ste 456J
Beverly, MA 01915-6132

Mailing address

67 Burnside Ave
East Hartford, CT 06108-3408
Phone (704) 506-6267

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral Care of Connecticut PC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1164292512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 BURNSIDE AVE",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083408",
            "telephone_number": "704-506-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CUMMINGS CTR STE 456J",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156132",
            "telephone_number": "978-296-3460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-06",
        "status": "A",
        "authorized_official_last_name": "BRONSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "STACEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-222-3121"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.