Patricia Agnes Ieraci, LPCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5587 Issued in CT

Practice address

670 Main St S
Woodbury, CT 06798-3738

Phone

(203) 263-3175

NPI assigned

Jun 23, 2022

Sex

Female

Sole proprietor

Yes

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.

• Inner Oasis Psychotherapy

  • Professional Counselor
  • Meriden, CT
  • NPI 1639936040

  Professional

  NPD Authorized official
• A Wave of Change

  • Addiction (Substance Use Disorder) Counselor
  • Waterbury, CT
  • NPI 1063187672
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2022.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1629709290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 LYDALE PL",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064506100",
            "telephone_number": "860-874-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 MAIN ST S",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067983738",
            "telephone_number": "203-263-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IERACI",
        "first_name": "PATRICIA",
        "middle_name": "AGNES",
        "credential": "LPCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "5587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Woodbury, CT
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.