Active NPI
Amy A Gorin, PH.D.
- Health Psychologist
- Mansfield Center, CT
National Provider Identifier
1336455807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 003020
- Practice address
- 18 Ledgebrook Dr
Mansfield Center, CT 06250-1664 - Phone
- (860) 634-1925
- NPI assigned
- Aug 23, 2010
- 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 |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | 003020 | CT | Primary |
Addresses
Primary practice location
18 Ledgebrook Dr
Mansfield Center, CT 06250-1664
Mailing address
42 Michelle LN
Mansfield Center, CT 06250-1652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003020 | CT | MD | Health Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282867200000",
"number": "1336455807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 MICHELLE LN",
"city": "MANSFIELD CENTER",
"state": "CT",
"postal_code": "062501652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 LEDGEBROOK DR",
"city": "MANSFIELD CENTER",
"state": "CT",
"postal_code": "062501664",
"telephone_number": "860-634-1925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORIN",
"first_name": "AMY",
"middle_name": "A",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-23",
"last_updated": "2010-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "CT",
"license": "003020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield Center, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.