Psy-Visions of Connecticut, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

54602 Issued in CT

Legal business name

PSY-VISIONS OF CONNECTICUT, LLC

Practice address

88 Main St S Ste B201
Southbury, CT 06488-2276

Phone

(203) 405-1745

Fax

(203) 405-1745

NPI assigned

May 22, 2017

Last updated

May 22, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark D. Stracks, MD, MS, MPHNPI 1437215456

Title

President

Phone

(706) 718-8056

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

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.

• Mark Douglas Stracks, MD, MS, MPH

  • Psychiatry Physician
  • Roxbury, CT
  • NPI 1437215456
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495411200000",
    "number": "1659808699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 WEEKEEPEEMEE RD",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067981621",
            "telephone_number": "706-718-8056",
            "fax_number": "203-405-1745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 MAIN ST S STE B201",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882276",
            "telephone_number": "203-405-1745",
            "fax_number": "203-405-1745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSY-VISIONS OF CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2017-05-22",
        "status": "A",
        "authorized_official_last_name": "STRACKS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-718-8056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MS, MPH"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "54602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Southbury, CT
• Providers in Southbury, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; 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.