NPIMap

Organization Active NPI

Emh Family Services PC

Doing business as Ellie Mental Health

  • Marriage & Family Therapist
  • Fairfield, CT
National Provider Identifier
1619611464
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
EMH FAMILY SERVICES PC
Doing business as
Ellie Mental Health
Practice address
55 Walls Dr
Ste 206
Fairfield, CT 06824-5163
Phone
(845) 656-3053
NPI assigned
Apr 26, 2022
Last updated
Nov 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Authorized official

Name
Mr. Michael Jay Pisco, LMFTNPI 1275873390
Title
Clinic Director
Phone
(845) 656-3053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

55 Walls Dr
Ste 206
Fairfield, CT 06824-5163

Mailing address

55 Walls Dr
Ste 206
Fairfield, CT 06824-5163
Phone (203) 689-8989

Other names 1

  • ELLIE MENTAL HEALTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230808003518 CT Part B Supplier - Clinic/Group Practice 9931561982 Receives reassigned benefits from 43 practitioners
Practice locations: Fairfield, CT; Ridgefield, CT

National Provider Directory

National Provider Directory

Locations

55 Walls Dr
Ste 206
Fairfield, CT 06824
Phone (203) 635-5776

38A Grove St
Ste 101
Ridgefield, CT 06877
Phone (203) 896-8888

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1619611464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WALLS DR",
            "address_2": "STE 206",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245163",
            "telephone_number": "203-689-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WALLS DR",
            "address_2": "STE 206",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245163",
            "telephone_number": "845-656-3053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMH FAMILY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-26",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "PISCO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "845-656-3053",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELLIE MENTAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ELLIE MENTAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 10, 2022; 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.