NPIMap

Organization Active NPI

Connecticut Behavioral Health Assoc, P.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New London, CT
National Provider Identifier
1629158126
Registry record updated Nov 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
Practice address
41 Fair Harbour PL
New London, CT 06320-4710
Phone
(860) 437-6914
Fax
(860) 437-6920
NPI assigned
Oct 17, 2006
Last updated
Nov 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2015

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

Authorized official

Name
Dr. Bassam Awwa, MDNPI 1881774354
Title
Medical Director
Phone
(860) 437-6914

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Professional Counselor 101YP2500X
Clinical Psychologist 103TC0700X
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

41 Fair Harbour PL
New London, CT 06320-4710

Mailing address

41 Fair Harbour PL
New London, CT 06320-4710
Phone (860) 437-6914

Other identifiers 6

IdentifierTypeStateIssuer
004192324MedicaidCT
004195774MedicaidCT
004199271MedicaidCT
008008065MedicaidCT
004255388MedicaidCT
004255411MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000567 CT Part B Supplier - Clinic/Group Practice 4385532373 Receives reassigned benefits from 45 practitioners
Practice locations: Hamden, CT; Southington, CT; Plainfield, CT; Pawcatuck, CT; Old Saybrook, CT; Norwich, CT; New London, CT; New Britain, CT…

National Provider Directory

National Provider Directory

Locations

200 Oak St
Ste C
Glastonbury, CT 06033
Phone (860) 657-8868

2969 Whitney Ave
Hamden, CT 06518
Phone (203) 691-7634

2969 Whitney Ave
Ste L1
Hamden, CT 06518

12 Case St
Ste 314
Norwich, CT 06360
Phone (860) 823-1399

22 Case St
Norwich, CT 06360
Phone (860) 437-6914

28 1/2 Case St
Norwich, CT 06360

954 Middlesex Tpke
#A3
Old Saybrook, CT 06475

954 Middlesex Tpke
Ste A3
Old Saybrook, CT 06475
Phone (860) 391-8661

118 S Broad St
Pawcatuck, CT 06379
Phone (860) 572-8834

13 Babcock Ave
Plainfield, CT 06374
Phone (860) 564-2242

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1629158126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 FAIR HARBOUR PL",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204710",
            "telephone_number": "860-437-6914",
            "fax_number": "860-437-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 FAIR HARBOUR PL",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204710",
            "telephone_number": "860-437-6914",
            "fax_number": "860-437-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "AWWA",
        "authorized_official_first_name": "BASSAM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "860-437-6914",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004192324",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004195774",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004199271",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008008065",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004255388",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004255411",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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.