NPIMap

Organization Active NPI

Glastonbury Psychological Associates, PC

  • Clinical Psychologist
  • Glastonbury, CT
National Provider Identifier
1184776593
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1008 Issued in CT
Legal business name
GLASTONBURY PSYCHOLOGICAL ASSOCIATES, PC
Practice address
300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176
Phone
(860) 659-1202
Fax
(860) 657-1535
NPI assigned
Jan 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jeffrey J. Magnavita, PH.D.NPI 1922280569
Title
Psychologist
Phone
(860) 659-1202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 1008 CT Primary

Addresses

Primary practice location

300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176

Mailing address

300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176
Phone (860) 659-1202

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184776593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE",
            "address_2": "SUITE 215",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332176",
            "telephone_number": "860-659-1202",
            "fax_number": "860-657-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE",
            "address_2": "SUITE 215",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332176",
            "telephone_number": "860-659-1202",
            "fax_number": "860-657-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLASTONBURY PSYCHOLOGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAGNAVITA",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "860-659-1202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "1008",
            "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 Aug 22, 2020; 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.