Active NPI
Mary Beth Golja, LMFT MA
- Marriage & Family Therapist
- Madison, CT
National Provider Identifier
1669537700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 000496
- Practice address
- 55 Bradley Road
Madison, CT 06443 - Phone
- (203) 245-3317
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 000496 | CT | Primary |
Addresses
Primary practice location
55 Bradley Road
Madison, CT 06443
Mailing address
55 Bradley Road
Madison, CT 06443
Phone (203) 245-3317
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410000496CT01 | Other | CT | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669537700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 BRADLEY ROAD",
"city": "MADISON",
"state": "CT",
"postal_code": "06443",
"telephone_number": "203-245-3317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 BRADLEY ROAD",
"city": "MADISON",
"state": "CT",
"postal_code": "06443",
"telephone_number": "203-245-3317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLJA",
"first_name": "MARY",
"middle_name": "BETH",
"name_prefix": "Mrs.",
"credential": "LMFT MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CT",
"license": "000496",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "410000496CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.