Marylliam Gagne, LCSW
Individual provider Active NPI Clinical Social Worker · Enfield, CT
NPI 1427430503 · NPPES record last updated Aug 17, 2015
Key facts
- NPI
- 1427430503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 008472 (CT)
- Practice address
- 153 Hazard Ave FL 1
Enfield, CT 06082-5444 - Phone
- (860) 253-5020
- NPI assigned
- Jun 24, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.63 of 100
- Quality
- 75.35
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 71.44
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150910001325 | CT | Practitioner - Clinical Social Worker | 0749597623 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008472 | CT | MD | Clinical Social Worker |
| 8472 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities Inc - Archdiocese of Hartford | Current |
Accepting new patients | |
| The Charlotte Hungerford Hospital | Current |
Accepting new patients | |
| The Charlotte Hungerford Hospital | Current |
Accepting new patients | |
| Community Health Resources, Inc. | Current |
Accepting new patients | |
| State of Connecticut | Current |
Accepting new patients | |
| Catholic Charities, Inc. - Archdiocese of Hartford | Current |
Accepting new patients | |
| State of Connecticut | Current |
Accepting new patients |
Locations
153 Hazard Ave
Enfield, CT 06082
Phone (860) 253-5020
153 Hazard Ave
Fl 1
Enfield, CT 06082
Phone (860) 253-5020
45 Wadsworth St
Hartford, CT 06106
Phone 8605271124283
896 Asylum Ave
Hartford, CT 06105
Phone (860) 522-8241
450 Columbus Blvd
Ste 1001
Hartford, CT 06103
500 Vine St
Hartford, CT 06112
Phone (860) 293-6400
540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361
995 Day Hill Rd
Windsor, CT 06095
Phone (860) 697-3351
2 Waterside Xing
Ste 401
Windsor, CT 06095
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/ccaoh/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 008472 | CT | Yes |
Addresses
Primary practice location
153 Hazard Ave FL 1
Enfield, CT 06082-5444
Mailing address
995 Day Hill Rd
Windsor, CT 06095-1722
Phone (860) 731-5522
Other providers in Enfield, CT
- Ramona M Frost
- Karlyn Frye
- Leslie Fultz
- Laura Fusari
- Rebecca Suzzanne Gaffron
- Justin C Gagnon
- Rona Gainen
- Connie Ying Gao
- Rachel Garcia
- Yvonne Gardner
All providers in Enfield, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.