NPIMap

Organization Active NPI

Optum Behavioral Care of Connecticut, P.C.

  • Counseling Psychologist
  • Woburn, MA
National Provider Identifier
1205617370
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Practice address
10 Cedar St Ste 34
Woburn, MA 01801-6365
Phone
(781) 221-3180
NPI assigned
Oct 13, 2023
Last updated
Dec 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Authorized official

Name
Amanda BronsonNPI 1043591167
Title
Ceo
Phone
(978) 222-3121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X NU Primary

Addresses

Primary practice location

10 Cedar St Ste 34
Woburn, MA 01801-6365

Mailing address

67 Burnside Ave
East Hartford, CT 06108-3408
Phone (952) 246-4564

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240311000793 MA Part B Supplier - Clinic/Group Practice 9436502879 Receives reassigned benefits from 93 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerville, MA; Newton, MA; Boston, MA; Newburyport, MA; Marlborough, MA; Danvers, MA; Burlington, MA; Brookline, MA…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral Care of CT16 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

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1205617370",
    "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": "952-246-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CEDAR ST STE 34",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018016365",
            "telephone_number": "781-221-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-13",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "BRONSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-222-3121"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; 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.