NPIMap

Organization Active NPI

Psychiatric Medicine Center, PC

  • Psychiatric/Mental Health Nurse Practitioner
  • New London, CT
National Provider Identifier
1376692111
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PSYCHIATRIC MEDICINE CENTER, PC
Practice address
501 Ocean Ave
New London, CT 06320-4521
Phone
(860) 442-6364
Fax
(860) 447-9977
NPI assigned
Jan 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Pamela Graves
Title
Credentialer
Phone
(860) 442-6364

Specialties & licenses 1

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

Addresses

Primary practice location

501 Ocean Ave
New London, CT 06320-4521

Mailing address

501 Ocean Ave
New London, CT 06320-4521
Phone (860) 442-6364

National Provider Directory

National Provider Directory
Tax ID family
Psychiatric Medicine Center PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376692111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 OCEAN AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204521",
            "telephone_number": "860-442-6364",
            "fax_number": "860-447-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 OCEAN AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204521",
            "telephone_number": "860-442-6364",
            "fax_number": "860-447-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC MEDICINE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CREDENTIALER",
        "authorized_official_telephone_number": "860-442-6364"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.