NPIMap

Organization Active NPI

Psychological Health Associates LLC

  • Professional Counselor
  • Bloomfield, CT
National Provider Identifier
1508899212
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
PSYCHOLOGICAL HEALTH ASSOCIATES LLC
Practice address
701 Cottage Grove Rd Ste 302
Bloomfield, CT 06002-3080
Phone
(860) 233-9772
Fax
(860) 236-9402
NPI assigned
Jul 8, 2006
Last updated
Aug 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Authorized official

Name
Dr. Marci B. Korwin, PHDNPI 1760415475
Title
Principal
Phone
(860) 233-9772

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Group Psychotherapy Psychologist 103TP2701X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

701 Cottage Grove Rd Ste 302
Bloomfield, CT 06002-3080

Mailing address

701 Cottage Grove Rd Ste C210
Bloomfield, CT 06002-4207
Phone (860) 233-9772

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040302001063 CT Part B Supplier - Clinic/Group Practice 9638066822 Receives reassigned benefits from 12 practitioners
Practice locations: Bloomfield, CT

National Provider Directory

National Provider Directory

Locations

701 Cottage Grove Rd
Ste 302
Bloomfield, CT 06002
Phone (860) 233-9772

701 Cottage Grove Rd
Ste C210
Bloomfield, CT 06002
Phone (860) 233-9772

345 N Main St
Ste 302
West Hartfrd, CT 06117
Phone (860) 233-9772

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1508899212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD STE C210",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060024207",
            "telephone_number": "860-233-9772",
            "fax_number": "860-236-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD STE 302",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-233-9772",
            "fax_number": "860-236-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL HEALTH ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "KORWIN",
        "authorized_official_first_name": "MARCI",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "860-233-9772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.