NPIMap

Organization Active NPI

Connecticut Pediatric Neuropsychology Associates

  • Clinical Neuropsychologist
  • Glastonbury, CT
National Provider Identifier
1306627708
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
CONNECTICUT PEDIATRIC NEUROPSYCHOLOGY ASSOCIATES
Practice address
300 Hebron Ave Ste 111
Glastonbury, CT 06033-2176
Phone
(860) 633-8155
Fax
(860) 633-8176
NPI assigned
Oct 11, 2023
Last updated
Oct 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Dr. Gary M. Isenberg, PSY.D.NPI 1700502937
Title
Pediatric Neuropsychologist
Phone
(860) 633-8155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X Primary

Addresses

Primary practice location

300 Hebron Ave Ste 111
Glastonbury, CT 06033-2176

Mailing address

300 Hebron Ave Ste 111
Glastonbury, CT 06033-2176
Phone (860) 633-8155

National Provider Directory

National Provider Directory

Locations

300 Hebron Ave
Ste 111
Glastonbury, CT 06033
Phone (860) 633-8155

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1306627708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE STE 111",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332176",
            "telephone_number": "860-633-8155",
            "fax_number": "860-633-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE STE 111",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332176",
            "telephone_number": "860-633-8155",
            "fax_number": "860-633-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT PEDIATRIC NEUROPSYCHOLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "ISENBERG",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PEDIATRIC NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "860-633-8155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; 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.