Individual provider Active NPI

Christine Gonzalez, MA, LPC

  • Professional Counselor
  • Middlebury, CT
National Provider Identifier
1366995904
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4647 Issued in CT
Practice address
984 Southford Rd
Middlebury, CT 06762-3234
Phone
(203) 758-2400
NPI assigned
Aug 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 4647 CT Primary

Addresses

Primary practice location

984 Southford Rd
Middlebury, CT 06762-3234

Mailing address

984 Southford Rd
Middlebury, CT 06762-3234
Phone (203) 758-2400

Other practice location 1

55 Walls Dr Ste 206
Fairfield, CT 06824-5180
Phone (203) 689-8989

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
I20240125001852 CT Practitioner - Mental Health Counselor 2860845922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Behavioral Health Center for Counseling and Learning LLCGroup PAC ID 8729313135, 27 clinicians

Practice addresses (Care Compare)

984 Southford Rd
Middlebury, CT 06762-3234
Phone (203) 758-2400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4647CTMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Compassionate Care Counseling LLC Professional CurrentSince Mar 28, 2021 Accepting new patients
Emh Family Services PC CurrentSince Apr 15, 2024 Accepting new patients

Locations

55 Walls Dr
Ste 206
Fairfield, CT 06824
Phone (203) 635-5776

984 Southford Rd
Middlebury, CT 06762
Phone (203) 758-2400

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.

NPI Registry JSON

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

{
    "created_epoch": "1470009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1366995904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 SOUTHFORD RD",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067623234",
            "telephone_number": "203-758-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 SOUTHFORD RD",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067623234",
            "telephone_number": "203-758-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Walls Dr Ste 206",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CT",
            "postal_code": "068245180",
            "country_code": "US",
            "telephone_number": "203-689-8989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "CHRISTINE",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-01",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "4647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, CT

Sources for this page

Verify at the official NPI Registry.