Connie Richer Fanelli, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001446 Issued in CT

Practice address

32 Copperfield Dr
Madison, CT 06443-1886

Phone

(203) 530-8862

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Connecticut Psychiatric Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • New London, CT
  • NPI 1255572079
  NPD (past)
• KC Chiropractic

  • Exclusive Provider Organization
  • Madison, CT
  • NPI 1487905386
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1518067313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 COPPERFIELD DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431886",
            "telephone_number": "203-530-8862",
            "fax_number": "203-530-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 COPPERFIELD DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431886",
            "telephone_number": "203-530-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANELLI",
        "first_name": "CONNIE",
        "middle_name": "RICHER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004084547",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serle Mindell Epstein, M.D.
• Michael Robert Espelin, APRN, PMHNP
• Estela Lopez LCSW LLC
• Harry M Eudowe, DDS
• Jordan Faigen
• Katherine Elizabeth Farnsworth, PA-C
• Lucy Kaitlyn Faulkner, MA
• John Vincent Federico, M.D.
• Heather Feiner, ATC/LAT
• Kristine Fernerud, LPCA

• Clinical Psychologist in Madison, CT
• Providers in Madison, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.