Alexandra Gozzola
Individual provider Active NPI Professional Counselor · Niantic, CT
NPI 1295383370 · NPPES record last updated Aug 31, 2019
Key facts
- NPI
- 1295383370
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 003690 (CT)
- Practice address
- 8 W Main St
Niantic, CT 06357-2303 - Phone
- (860) 451-9364
- NPI assigned
- Aug 31, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240125002186 | CT | Practitioner - Mental Health Counselor | 0042663114 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3690 | CT | MD | General Practice Dentistry |
| 003690 | CT | MD | Adult Psychiatric/Mental Health Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Community and Family Services, Inc. | Current |
Accepting new patients | |
| United Community and Family Services, Inc. | Professional | Current |
Accepting new patients |
Locations
70 Main St
Jewett City, CT 06351
Phone (860) 376-7040
47 Town St
Norwich, CT 06360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 003690 | CT | Yes |
Addresses
Primary practice location
8 W Main St
Niantic, CT 06357-2303
Mailing address
128 Flanders Rd
Niantic, CT 06357-1527
Other providers in Niantic, CT
- Gail Demarco, PHD
- Pamela S. Garcia
- Patricia Giannattasio
- Robert Paul Goldberg
- David L Goldschneider
- Judith F. Gruber
- Eileen Grudier
- Guardian Health Center, PA
- Diane Guardiani
- Monica Guyot
All providers in Niantic, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.