Individual provider Active NPI

Stacey Mae Hansen, LMFT

  • Marriage & Family Therapist
  • South Windsor, CT
National Provider Identifier
1336385871
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
001227 Issued in CT
Practice address
925 Sullivan Ave
Unit 2
South Windsor, CT 06074-2025
Phone
(860) 432-7771
Fax
(860) 432-7774
NPI assigned
Jan 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 001227 CT Primary

Addresses

Primary practice location

925 Sullivan Ave
Unit 2
South Windsor, CT 06074-2025

Mailing address

925 Sullivan Ave
Unit 2
South Windsor, CT 06074-2025
Phone (860) 432-7771

Other identifiers 1

IdentifierTypeStateIssuer
008025577MedicaidCT

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240513002333 CT Practitioner - Marriage and Family Therapist 5395186001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

925 Sullivan Ave
Suite 2
South Windsor, CT 06074-2080
Phone (860) 432-7771

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1227CTMDAddiction (Substance Use Disorder) Counselor
001227CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Art of Therapy, LLC. Marriage & Family Therapist CurrentSince Mar 11, 2024 Accepting new patients

Locations

925 Sullivan Ave
Ste 2
South Windsor, CT 06074
Phone (860) 432-7771

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": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1336385871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 SULLIVAN AVE",
            "address_2": "UNIT 2",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742025",
            "telephone_number": "860-432-7771",
            "fax_number": "860-432-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 SULLIVAN AVE",
            "address_2": "UNIT 2",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742025",
            "telephone_number": "860-432-7771",
            "fax_number": "860-432-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "STACEY",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-06",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "001227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008025577",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Windsor, CT

Sources for this page

Verify at the official NPI Registry.