Individual provider Active NPI

Jeffrey F Liddle

  • Professional Counselor
  • Hartford, CT
National Provider Identifier
1437203148
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
000768 Issued in CT
Practice address
675 Tower Ave
Suite 301
Hartford, CT 06112-1260
Phone
(860) 714-2750
Fax
(860) 714-8591
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 000768 CT Primary

Addresses

Primary practice location

675 Tower Ave
Suite 301
Hartford, CT 06112-1260

Mailing address

675 Tower Avenue
Suite 301
Hartford, CT 06112-1256
Phone (860) 714-2750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
000768CTMDProsthetic/Orthotic Supplier

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1437203148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 TOWER AVENUE",
            "address_2": "SUITE 301",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121256",
            "telephone_number": "860-714-2750",
            "fax_number": "860-714-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 TOWER AVE",
            "address_2": "SUITE 301",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121260",
            "telephone_number": "860-714-2750",
            "fax_number": "860-714-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDLE",
        "first_name": "JEFFREY",
        "middle_name": "F",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "000768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.