Individual provider Active NPI

Susan Elizabeth D'Ambrosio, PSY.D.

  • Clinical Psychologist
  • Hartford, CT
National Provider Identifier
1225074420
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
002626 Issued in CT
Practice address
79 Retreat Avenue
Hartford Hospital Psychiatry Dept
Hartford, CT 06106-2527
Phone
(860) 972-0200
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 002626 CT Primary

Addresses

Primary practice location

79 Retreat Avenue
Hartford Hospital Psychiatry Dept
Hartford, CT 06106-2527

Mailing address

79 Retreat Avenue
Hartford Hospital Psychiatry Dept
Hartford, CT 06106-2527
Phone (860) 972-0200

Other identifiers 1

IdentifierTypeStateIssuer
008026262MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050829000042 CT Practitioner - Clinical Psychologist 7810928033 Reassigns benefits to 3 organizations
I20230112002323 NY Practitioner - Clinical Psychologist 7810928033 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

79 Retreat Ave
Hartford, CT 06106-2527
Phone (860) 972-7182

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002626CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bio Behavioral Psychology P.C. Clinical CurrentSince Dec 12, 2022 Accepting new patients
Hartford Pathology Associates, P.C. Current Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jun 22, 2021 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Jun 22, 2021 Accepting new patients
Hartford Healthcare Medical Group, Inc CurrentSince Mar 1, 2017 Accepting new patients
Knapp Street Psychiatry, PC Clinical CurrentSince Apr 15, 2024 Accepting new patients
Hartford Hospital CurrentSince Jan 17, 2017 Accepting new patients
Che Senior Psychological Services, PC Clinical CurrentSince Apr 15, 2024 Accepting new patients

Locations

79 Retreat Ave
Hartford, CT 06106
Phone (860) 545-0200

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1915 Ocean Ave
Brooklyn, NY 11230
Phone (718) 258-7700

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

935 Northern Blvd
Ste 102
Great Neck, NY 11021
Phone (516) 487-7116

100 Park Ave
Fl 16
New York, NY 10017
Phone (212) 433-2384

209 Beach 125th St
Rockaway Park, NY 11694
Phone (516) 721-7625

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

Interoperability endpoints

  • Direct secure messaging: susan.dambrosio@xdr.hhchealthdirect.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1225074420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 RETREAT AVENUE",
            "address_2": "HARTFORD HOSPITAL PSYCHIATRY DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062527",
            "telephone_number": "860-972-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 RETREAT AVENUE",
            "address_2": "HARTFORD HOSPITAL PSYCHIATRY DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062527",
            "telephone_number": "860-972-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AMBROSIO",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008026262",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.