NPIMap

Organization Active NPI

Wellspring Psychological Services, LLC

  • Psychologist
  • Farmington, CT
National Provider Identifier
1366939191
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3717 Issued in CT
Legal business name
WELLSPRING PSYCHOLOGICAL SERVICES, LLC
Practice address
3 Forest Park Dr Ste 101
Farmington, CT 06032-1468
Phone
(860) 470-4560
NPI assigned
Apr 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Authorized official

Name
Dr. Megan Clarke, PH.D.NPI 1578062295
Title
Owner
Phone
(860) 470-4560

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
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 3717 CT Primary

Addresses

Primary practice location

3 Forest Park Dr Ste 101
Farmington, CT 06032-1468

Mailing address

26 Midlands Dr
West Hartford, CT 06107-1022
Phone (860) 874-4300

National Provider Directory

National Provider Directory

Locations

3 Forest Park Dr
Ste 101
Farmington, CT 06032
Phone (860) 470-4560

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1366939191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 MIDLANDS DR",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061071022",
            "telephone_number": "860-874-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 FOREST PARK DR STE 101",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321468",
            "telephone_number": "860-470-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-470-4560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CT",
            "license": "3717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.