Active NPI
Michelle R. Willard, M.A.
- Clinical Psychologist
- Simsbury, CT
National Provider Identifier
1245539477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2016
- Practice address
- 1 Grist Mill LN
Simsbury, CT 06070-2485 - Phone
- (860) 325-2176
- NPI assigned
- Mar 28, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2016 | CT | Primary |
Addresses
Primary practice location
1 Grist Mill LN
Simsbury, CT 06070-2485
Mailing address
31 Firetown Rd
West Granby, CT 06090-1612
Phone (860) 325-2176
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240409000409 | CT | Practitioner - Mental Health Counselor | 9234577354 | Practice locations: Glastonbury, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
104 Hale Rd
Glastonbury, CT 06033-3320
345 R New London Tpke
Glastonbury, CT 06033-3320
Phone (860) 325-2176
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301270400000",
"number": "1245539477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 FIRETOWN RD",
"city": "WEST GRANBY",
"state": "CT",
"postal_code": "060901612",
"telephone_number": "860-325-2176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GRIST MILL LN",
"city": "SIMSBURY",
"state": "CT",
"postal_code": "060702485",
"telephone_number": "860-325-2176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "MICHELLE",
"middle_name": "R.",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-28",
"last_updated": "2011-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "2016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simsbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.