Active NPI
Ellen Szumigala, LPC
- Professional Counselor
- Waterbury, CT
National Provider Identifier
1306097340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 001689
- Practice address
- 4 Midland Rd
Waterbury, CT 06705-3412 - Phone
- (203) 755-8874
- Fax
- (203) 597-9570
- NPI assigned
- Oct 8, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 001689 | CT | Primary |
Addresses
Primary practice location
4 Midland Rd
Waterbury, CT 06705-3412
Mailing address
4 Midland Rd
Waterbury, CT 06705-3412
Phone (203) 755-8874
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
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1068 W Main St
1St FL.
Waterbury, CT 06708-2676
Phone (203) 518-4526
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001689 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revive Wellness LLC | Professional | Current | Accepting new patients |
Locations
1068 W Main St
Ste 1
Waterbury, CT 06708
Phone (203) 518-4526
1068 W Main St
Waterbury, CT 06708
Phone (203) 518-4526
Organizations & group practices 1
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": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1306097340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 MIDLAND RD",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067053412",
"telephone_number": "203-755-8874",
"fax_number": "203-597-9570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 MIDLAND RD",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067053412",
"telephone_number": "203-755-8874",
"fax_number": "203-597-9570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SZUMIGALA",
"first_name": "ELLEN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "001689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.