Individual provider Active NPI

Amanda Fontaine-Iskra, LPC

  • Professional Counselor
  • Middletown, CT
National Provider Identifier
1295509420
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6945 Issued in CT
Practice address
675 Main St
Middletown, CT 06457-2732
Phone
(860) 347-6971
Fax
(860) 638-6831
NPI assigned
Nov 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6945 CT Primary

Addresses

Primary practice location

675 Main St
Middletown, CT 06457-2732

Mailing address

575 Main St Ste 2
Middletown, CT 06457-0010
Phone (860) 347-6971

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240122002769 CT Practitioner - Mental Health Counselor 8426407974 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6945CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc CurrentSince Jan 1, 2024 Accepting new patients
Community Health Center Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

575 Main St
Ste 2
Middletown, CT 06457

Interoperability endpoints

  • Direct secure messaging: amanda.fontaineiskra@chcict.eclinicaldirectplus.com

Organizations & group practices 2

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": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1295509420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MAIN ST STE 2",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064570010",
            "telephone_number": "860-347-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572732",
            "telephone_number": "860-347-6971",
            "fax_number": "860-638-6831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTAINE-ISKRA",
        "first_name": "AMANDA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-08",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "6945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

Verify at the official NPI Registry.