Individual provider Active NPI

Michael Suraci, LCSW, LADC

  • Clinical Social Worker
  • New Haven, CT
National Provider Identifier
1629436258
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
008720 Issued in CT
Practice address
34 Park St
New Haven, CT 06519-1109
Phone
(203) 974-7300
NPI assigned
Feb 10, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 001005 CT
Clinical Social Worker 1041C0700X 008720 CT Primary

Addresses

Primary practice location

34 Park St
New Haven, CT 06519-1109

Mailing address

34 Park St
New Haven, CT 06519-1109
Phone (203) 974-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170224002029 CT Practitioner - Clinical Social Worker 4981988623 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shoreline Wellness Behavioral Health Outreach IncGroup PAC ID 1951796119, 16 clinicians

Practice addresses (Care Compare)

415 Main St
West Haven, CT 06516-4296
Phone (203) 931-1184

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008720CTMDClinical Social Worker
001005CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shoreline Wellness Center, LLC. Clinical CurrentSince May 6, 2021 Accepting new patients
Bhcare, Inc. CurrentSince Feb 6, 2017 Accepting new patients
Shoreline Wellness Behavioral Health Outreach Inc CurrentSince Jul 13, 2022 Accepting new patients

Locations

435 E Main St
Ansonia, CT 06401
Phone (203) 736-2601

14 Sycamore Way
Branford, CT 06405
Phone (203) 483-2630

127 Washington Ave
Ste 3W
North Haven, CT 06473

415 Main St
Lowr
West Haven, CT 06516

415 Main St
West Haven, CT 06516
Phone (203) 931-1184

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/BHcare/r4/

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1629436258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191109",
            "telephone_number": "203-974-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191109",
            "telephone_number": "203-974-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURACI",
        "first_name": "MICHAEL",
        "credential": "LCSW, LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-10",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "001005",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.