CMC Psychological Associates, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002229 Issued in CT

Legal business name

CMC PSYCHOLOGICAL ASSOCIATES, LLC

Practice address

300 Hebron Ave Ste 215
Suite 215
Glastonbury, CT 06033-2192

Phone

(860) 657-8545

Fax

(860) 657-8482

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Martin Carlson, PSY.D.

Title

Member

Phone

(860) 657-8545

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396870101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE STE 215",
            "address_2": "SUITE 215",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332192",
            "telephone_number": "860-657-8545",
            "fax_number": "860-657-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE STE 215",
            "address_2": "SUITE 215",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332192",
            "telephone_number": "860-657-8545",
            "fax_number": "860-657-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "860-657-8545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.