Individual provider Active NPI

Anna J Mangiafico, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Farmington, CT
National Provider Identifier
1366027286
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
9615 Issued in CT
Practice address
270 Farmington Ave Ste 309
Farmington, CT 06032-1953
Phone
(860) 677-5570
NPI assigned
Mar 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 9615 CT Primary

Addresses

Primary practice location

270 Farmington Ave Ste 309
Farmington, CT 06032-1953

Mailing address

PO Box 486
Broad Brook, CT 06016-0486
Phone (860) 970-3177

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210616001832 CT Practitioner - Nurse Practitioner 0446650253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

201 Chestnut Hill Rd
Stafford Springs, CT 06076-4005
Phone (860) 684-4251

Hospital & facility affiliations

  • Johnson Memorial Hospital Hospital, Stafford Springs, CT, CCN 070008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9615CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Jan 1, 2023 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Jan 1, 2023 Accepting new patients
Connecticut Mental Health Specialists Inc Psychiatric/Mental Health CurrentSince May 1, 2021 Accepting new patients

Locations

270 Farmington Ave
Ste 309
Farmington, CT 06032
Phone (860) 677-5570

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

201 Chestnut Hill Rd
Stafford Springs, CT 06076
Phone (860) 265-6521

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1366027286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 486",
            "city": "BROAD BROOK",
            "state": "CT",
            "postal_code": "060160486",
            "telephone_number": "860-970-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 FARMINGTON AVE STE 309",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321953",
            "telephone_number": "860-677-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIAFICO",
        "first_name": "ANNA",
        "middle_name": "J",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "9615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.