Active NPI
Stefanie Bourassa, MSPT
- Specialist
- Enfield, CT
National Provider Identifier
1497925283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 008279
- Practice address
- 145 Hazard Ave
Suite B
Enfield, CT 06082-4521 - Phone
- (860) 265-2571
- Fax
- (860) 265-2574
- NPI assigned
- Mar 7, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008279 | CT | MD | Clinical Social Worker |
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 008279 | CT | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
145 Hazard Ave
Suite B
Enfield, CT 06082-4521
Mailing address
145 Hazard Ave
Suite B
Enfield, CT 06082-4521
Phone (860) 265-2571
Other identifiers 1
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51084 | Other | CT | BIRTHDATE |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 7, 2008.
{
"created_epoch": "1204848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204848000000",
"number": "1497925283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 HAZARD AVE",
"address_2": "SUITE B",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060824521",
"telephone_number": "860-265-2571",
"fax_number": "860-265-2574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 HAZARD AVE",
"address_2": "SUITE B",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060824521",
"telephone_number": "860-265-2571",
"fax_number": "860-265-2574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURASSA",
"first_name": "STEFANIE",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-07",
"last_updated": "2008-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CT",
"license": "008279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BIRTHDATE",
"identifier": "51084",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.