NPIMap

Organization Active NPI

CT Psychological & Assessment Center LLC

  • Professional Counselor
  • Wethersfield, CT
National Provider Identifier
1326342858
Registry record updated Apr 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
1997 Issued in CT
Legal business name
CT PSYCHOLOGICAL & ASSESSMENT CENTER LLC
Practice address
61 Wells Rd
Wethersfield, CT 06109-3043
Phone
(860) 372-4811
Fax
(860) 372-4812
NPI assigned
Dec 23, 2010
Last updated
Apr 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2014

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

Authorized official

Name
Lilliam Martinez, LPCNPI 1255632311
Title
Owner
Phone
(860) 372-4811

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3809 CT
Professional Counselor 101YP2500X 1997 CT Primary
Counseling Psychologist 103TC1900X 1820 CT
Clinical Social Worker 1041C0700X 7260 CT
Clinical Social Worker 1041C0700X 4480 CT
Clinical Social Worker 1041C0700X 3634 CT
Clinical Social Worker 1041C0700X 7279 CT
Clinical Social Worker 1041C0700X 5985 CT

Addresses

Primary practice location

61 Wells Rd
Wethersfield, CT 06109-3043

Mailing address

1028 Manchester Rd
Glastonbury, CT 06033-2617
Phone (860) 372-4811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111219000074 CT Part B Supplier - Clinic/Group Practice 6305011404 Receives reassigned benefits from 2 practitioners
Practice locations: Glastonbury, CT

National Provider Directory

National Provider Directory
Tax ID family
CT Psychological Assessment Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2934 Main St
Ste 2
Glastonbury, CT 06033
Phone (860) 372-4811

61 Wells Rd
Wethersfield, CT 06109
Phone (860) 372-4811

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": "1293062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397433600000",
    "number": "1326342858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 MANCHESTER RD",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332617",
            "telephone_number": "860-372-4811",
            "fax_number": "860-372-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 WELLS RD",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061093043",
            "telephone_number": "860-372-4811",
            "fax_number": "860-372-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CT PSYCHOLOGICAL & ASSESSMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-23",
        "last_updated": "2014-04-14",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-372-4811",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "3809",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "1997",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CT",
            "license": "1820",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "7260",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "4480",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "3634",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "7279",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "5985",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wethersfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.