NPIMap

Organization Active NPI

Supportive Solutions Behavioral Health and Wellness LLC

  • Clinical Social Worker
  • Hamden, CT
National Provider Identifier
1598260226
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SUPPORTIVE SOLUTIONS BEHAVIORAL HEALTH AND WELLNESS LLC
Practice address
2911 Dixwell Ave Ste 302
Hamden, CT 06518-3130
Phone
(203) 376-0220
NPI assigned
Mar 26, 2018
Last updated
Mar 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Authorized official

Name
Shalyn RoseNPI 1952650897
Title
Owner/LCSW
Phone
(203) 376-0220

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
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

2911 Dixwell Ave Ste 302
Hamden, CT 06518-3130

Mailing address

49 Englewood Dr
New Haven, CT 06515-2309

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180614001170 CT Part B Supplier - Clinic/Group Practice 6901151067 Receives reassigned benefits from 2 practitioners
Practice locations: Hamden, CT

National Provider Directory

National Provider Directory

Locations

114 S Main St
Ste 32
Cheshire, CT 06410

2911 Dixwell Ave
Ste 302
Hamden, CT 06518
Phone (203) 376-0220

2911 Dixwell Ave
Ste 307B
Hamden, CT 06518
Phone (203) 376-0220

Practitioners & affiliated clinicians

Practitioners 7

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": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1598260226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 ENGLEWOOD DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065152309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 DIXWELL AVE STE 302",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183130",
            "telephone_number": "203-376-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE SOLUTIONS BEHAVIORAL HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "SHALYN",
        "authorized_official_title_or_position": "OWNER/LCSW",
        "authorized_official_telephone_number": "203-376-0220"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; 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.