Jomary Sepulveda, LPC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4700 Issued in CT

Practice address

400 Columbus Ave
Apc
New Haven, CT 06519

Phone

(203) 503-3673

Fax

(203) 503-3600

NPI assigned

Jun 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Jomary Sepulveda-Betancourt Other name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornell Scott Hill Health Corporation

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
  • NPI 1902921380
  Medicare reassignment NPD
• JSB Wellness LLC

  • Psychologist
  • Hamden, CT
  • NPI 1407437056

  Professional

  NPD

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1174974471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COLUMBUS AVE",
            "address_2": "CREDENTIALING SPECIALIST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191233",
            "telephone_number": "203-503-3174",
            "fax_number": "203-503-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COLUMBUS AVE",
            "address_2": "APC",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06519",
            "telephone_number": "203-503-3673",
            "fax_number": "203-503-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "JOMARY",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "3521",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "4700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235918",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOMARY",
            "last_name": "SEPULVEDA-BETANCOURT",
            "prefix": "DR.",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Audrey P Senior, APRN
• Christine Senu, MFT
• Dongju Seo, PHD
• Lonnie Seo
• Teresa H Seo, PHARMD
• Serenity Counseling and Services. LLC
• Serenity Nursing Staff
• Andrew Serio
• Joseph Charles Serio, PHARMD
• Michelle Serlin, M.D.

• Psychologist in New Haven, CT
• Providers in New Haven, CT by specialty
• Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.