Ian Zettervall, LPC, LADC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

46.003558 Issued in CT

Practice address

61 Bradley St
Bristol, CT 06010-5103

Phone

(860) 863-1937

NPI assigned

Jul 3, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Tragrad Therapy LLC

  • Marriage & Family Therapist
  • Bristol, CT
  • NPI 1801520721
  NPD Authorized official

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1649791310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 BREWSTER RD",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105212",
            "telephone_number": "860-630-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 BRADLEY ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105103",
            "telephone_number": "860-863-1937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZETTERVALL",
        "first_name": "IAN",
        "credential": "LPC, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "001211",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CT",
            "license": "46.003558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorna Zammett, RPH
• Natori Zaums
• Helen J Zervas, OD
• Craig Zettergren, PT
• Kathleen Zettergren, PT
• Lindsay Zimmitti, LCSW
• Ziogas Medical Supplies Plus, LLC
• George P. Zuk Jr., D.P.M.
• Richard M Zweig, MD

• Counselor in Bristol, CT
• Providers in Bristol, CT by specialty
• Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.