Individual provider Active NPI

Michaela U Kauffmann, PSYD

  • Psychologist
  • Waterbury, CT
National Provider Identifier
1487763413
Registry record updated Sep 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
001965 Issued in CT
Practice address
133 Scovill St
Suite 211
Waterbury, CT 06706-1127
Phone
(203) 573-9521
Fax
(203) 573-8708
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 001965 CT Primary

Addresses

Primary practice location

133 Scovill St
Suite 211
Waterbury, CT 06706-1127

Mailing address

133 Scovill St
Suite 211
Waterbury, CT 06706-1127
Phone (203) 573-9521

Other identifiers 2

IdentifierTypeStateIssuer
060001965CT01OtherCTBLUE SHIELD
004144333MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20260413000117 NY Practitioner - Clinical Psychologist 4284640855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

600 3Rd Ave
FL 2
New York, NY 10016-1909

600 3Rd Ave FL
Suite 2
New York, NY 10016-1919

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
026271NYMDPhysical Therapist
1965CTMDMedical Physician Assistant

Organizations & group practices 1

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283385600000",
    "number": "1487763413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 SCOVILL ST",
            "address_2": "SUITE 211",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061127",
            "telephone_number": "203-573-9521",
            "fax_number": "203-573-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 SCOVILL ST",
            "address_2": "SUITE 211",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061127",
            "telephone_number": "203-573-9521",
            "fax_number": "203-573-8708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFFMANN",
        "first_name": "MICHAELA",
        "middle_name": "U",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "001965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "060001965CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004144333",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.