Individual provider Active NPI

Ladie Juszkiewicz, LPC

  • Professional Counselor
  • Waterbury, CT
National Provider Identifier
1609532357
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5906 Issued in CT
Practice address
1279 W Main St
Waterbury, CT 06708-3101
Phone
(203) 755-5490
NPI assigned
Nov 16, 2021
Last updated
May 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 9755 SC
Professional Counselor 101YP2500X 5906 CT Primary

Addresses

Primary practice location

1279 W Main St
Waterbury, CT 06708-3101

Mailing address

1279 West Main Street
Waterbury, CT 06708
Phone (203) 755-5490

Other practice location 1

698 Fairview Rd
Simpsonville, SC 29680-6708
Phone (475) 557-1593

Other practice location 2

73 Turner Ave
Oakville, CT 06779-1821
Phone (917) 656-0322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, SC, ME3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20240116000097 CT Practitioner - Mental Health Counselor 7214389204 Reassigns benefits to 2 organizations
I20240620004135 SC Practitioner - Mental Health Counselor 7214389204 Reassigns benefits to 2 organizations
I20250321002507 ME Practitioner - Mental Health Counselor 7214389204 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5906CTMDProfessional Counselor
9755SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Video Virtual Care, PLLC Professional CurrentSince May 24, 2024 Accepting new patients
MC Diagnostic of Connecticut, P.C. Professional CurrentSince Jan 1, 2024 Accepting new patients
Minuteclinic Diagnostic South Carolina LLC CurrentSince May 24, 2024 Accepting new patients
Minuteclinic Diagnostic of Maine, LLC CurrentSince Jan 23, 2025 Accepting new patients

Locations

3514 Main St
Coventry, CT 06238
Phone (860) 298-5925

1279 W Main St
Waterbury, CT 06708
Phone (203) 389-2727

51 Market St
South Portland, ME 04106
Phone (207) 799-2261

698 Fairview Rd
Simpsonville, SC 29680
Phone (864) 573-5313

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1609532357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1279 WEST MAIN STREET",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06708",
            "telephone_number": "203-755-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083101",
            "telephone_number": "203-755-5490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "698 Fairview Rd",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296806708",
            "country_code": "US",
            "telephone_number": "475-557-1593",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "73 Turner Ave",
            "address_purpose": "LOCATION",
            "city": "Oakville",
            "state": "CT",
            "postal_code": "067791821",
            "country_code": "US",
            "telephone_number": "917-656-0322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUSZKIEWICZ",
        "first_name": "LADIE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-16",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "9755",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "5906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.