NPIMap

Organization Active NPI

Family Resource Associates LLC

  • Adult Mental Health Clinic/Center
  • Stratford, CT
National Provider Identifier
1598844714
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
C-0209 Issued in CT
Legal business name
FAMILY RESOURCE ASSOCIATES LLC
Practice address
3300 Main St
Stratford, CT 06614
Phone
(203) 378-4514
Fax
(203) 378-0443
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Dr. Kathleen E Myers, LCSWNPI 1740226786
Title
Executive Director
Phone
(203) 378-4514

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X C-0209 CT Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 0309 CT

Addresses

Primary practice location

3300 Main St
Stratford, CT 06614

Mailing address

3300 Main St
Stratford, CT 06614
Phone (203) 378-4514

Other identifiers 1

IdentifierTypeStateIssuer
004125961MedicaidCT

Other names 1

  • Single Person LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110202000292 CT Part B Supplier - Clinic/Group Practice 0648450072 Receives reassigned benefits from 2 practitioners
Practice locations: Stratford, CT
O20220912001919 MA Part B Supplier - Clinic/Group Practice 0648450072 Receives reassigned benefits from 1 practitioner
Practice locations: Acton, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1598844714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 MAIN ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "06614",
            "telephone_number": "203-378-4514",
            "fax_number": "203-378-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 MAIN ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "06614",
            "telephone_number": "203-378-4514",
            "fax_number": "203-378-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY RESOURCE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-378-4514",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CT",
            "license": "C-0209",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "0309",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004125961",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Single Person LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stratford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.