NPIMap

Organization Active NPI

Fairfield County Child and Adolescent Therapy, LLC

  • Professional Counselor
  • Fairfield, CT
National Provider Identifier
1558762807
Registry record updated Sep 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2603 Issued in CT
Legal business name
FAIRFIELD COUNTY CHILD AND ADOLESCENT THERAPY, LLC
Practice address
34 Sherman CT
Fairfield, CT 06824-5826
Phone
(203) 260-1918
NPI assigned
Sep 5, 2014
Last updated
Sep 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2014

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

Authorized official

Name
Kristen Marie PeckNPI 1316347750
Title
LPC Therapist
Phone
(203) 260-1918

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 2603 CT Primary

Addresses

Primary practice location

34 Sherman CT
Fairfield, CT 06824-5826

Mailing address

102 Wheeler Rd
Monroe, CT 06468-2428
Phone (203) 260-1918

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409961600000",
    "number": "1558762807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WHEELER RD",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682428",
            "telephone_number": "203-260-1918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 SHERMAN CT",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245826",
            "telephone_number": "203-260-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD COUNTY CHILD AND ADOLESCENT THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-06",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "LPC THERAPIST",
        "authorized_official_telephone_number": "203-260-1918"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "2603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2014; 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.