Michael Andrew Widroff

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Practice address

1 Wahoo Ave
Groton, CT 06349-2324

Phone

(860) 694-4966

NPI assigned

Dec 10, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523491200000",
    "number": "1528433877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 E 17TH ST",
            "address_2": "APARTMENT 606",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112303751",
            "telephone_number": "917-402-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063492324",
            "telephone_number": "860-694-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDROFF",
        "first_name": "MICHAEL",
        "middle_name": "ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-10",
        "last_updated": "2018-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew D Whitbeck, IDC
• Kayla Arielle White
• Malissa D Wickersham, FNP
• Adedayo Widlak, PHARMD
• John Joseph Widlak Jr., D.M.D.
• Laurel Anne Wiers, LMFT
• Corey Robin Wilfon
• Audra Marie Wilks, M.S., CCC-SLP
• Terell Willard
• Marcus Williams

• Cognitive & Behavioral Psychologist in Groton, CT
• Providers in Groton, CT by specialty
• Cognitive & Behavioral Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.