Alicia Brengman, PHD, MS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

004342 Issued in CT

Practice address

500 Poquonnock Rd
Groton, CT 06340-4568

Phone

(860) 445-2191

Fax

(860) 449-1869

NPI assigned

Jan 14, 2019

Last updated

Jul 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Child and Family Agency of Southeastern Connecticut, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New London, CT
  • NPI 1093762114
  NPD (past)
• Child and Family Agency of Southeastern Connecticut, Inc.

  • Clinic/Center
  • Groton, CT
  • NPI 1881871168
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1306310255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206204",
            "telephone_number": "860-443-2896",
            "fax_number": "860-442-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 POQUONNOCK RD",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404568",
            "telephone_number": "860-445-2191",
            "fax_number": "860-449-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENGMAN",
        "first_name": "ALICIA",
        "name_prefix": "Dr.",
        "credential": "PHD, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-14",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "004342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Boyden, LMT
• Susan A Bradbury, PT
• Kevin Bradley
• Branch Medical Clinic Groton
• Thomas Braun, DDS
• Joanna L. Breton, APRN
• Stephen Jeffrey Brewer, PHD.
• Evelyn Marie Bridges, LCSW
• Bridgeworks LLC
• Allyn Patrick Brown

• Professional Counselor in Groton, CT
• Providers in Groton, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.