Active NPI
Kyoung Hi Song Dickson, LMFT
- Marriage & Family Therapist
- Bristol, CT
National Provider Identifier
1306134275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 001459
- Practice address
- 38 Kelley St
Bristol, CT 06010-5715 - Phone
- (860) 314-1236
- Fax
- (860) 314-1236
- NPI assigned
- Jul 13, 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 001459 | CT | Primary |
Addresses
Primary practice location
38 Kelley St
Bristol, CT 06010-5715
Mailing address
38 Kelley Street
Bristol, CT 06107
Phone (860) 314-1236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 26, 2024 through Sep 26, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1459 | CT | MD | Behavioral Analyst |
| 001459 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310515200000",
"number": "1306134275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 KELLEY STREET",
"city": "BRISTOL",
"state": "CT",
"postal_code": "06107",
"telephone_number": "860-314-1236",
"fax_number": "860-314-1236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38 KELLEY ST",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060105715",
"telephone_number": "860-314-1236",
"fax_number": "860-314-1236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKSON",
"first_name": "KYOUNG HI",
"middle_name": "SONG",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-13",
"last_updated": "2011-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CT",
"license": "001459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.