Farmington River Mental Health Specialists, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005693 Issued in CT

Legal business name

FARMINGTON RIVER MENTAL HEALTH SPECIALISTS, LLC

Practice address

46 W Avon Rd Ste 204
Avon, CT 06001-3679

Phone

(860) 307-8943

Fax

(860) 824-1469

NPI assigned

May 15, 2012

Last updated

Sep 29, 2014By 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

Mrs. Debra M Carroll, LCSW

Title

Director

Phone

(860) 307-8943

Specialties & licenses 2

Addresses

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.

• Debra M Mordecai, LCSW

  • Clinical Social Worker
  • Avon, CT
  • NPI 1093753808
  NPD (past)

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1669731360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 W AVON RD STE 204",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013679",
            "telephone_number": "860-307-8943",
            "fax_number": "860-824-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 W AVON RD STE 204",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013679",
            "telephone_number": "860-307-8943",
            "fax_number": "860-824-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARMINGTON RIVER MENTAL HEALTH SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-15",
        "last_updated": "2014-09-29",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "860-307-8943",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Essential Rheumatology LLC
• Samantha Eulie, PT, DPT
• Hope Michele Evelyn, MSW, LCSW
• Emily Reanne Everlith, DMD
• Rosemary Fanale, APRN
• Farmington Valley Counseling Center LLC
• Farmington Valley Dermatology and Surgery, LLC
• Farmington Valley Direct Primary Care
• Farmington Valley Integrative Therapy, LLC
• Farmington Valley Orthodontic Associates

• Clinical Social Worker in Avon, CT
• Providers in Avon, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; 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.