Organization Active NPI

Martin D Oliveira Psy D LLC

  • Clinical Neuropsychologist
  • West Hartford, CT
National Provider Identifier
1669824702
Registry record updated Jul 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
002930 Issued in CT
Legal business name
MARTIN D OLIVEIRA PSY D LLC
Practice address
10 N Main St Ste 1
West Hartford, CT 06107-1968
Phone
(860) 519-5227
Fax
(845) 728-0667
NPI assigned
Jul 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2016

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

Authorized official

Name
Martin Oliveira, PSY.DNPI 1255565479
Title
Owner
Phone
(860) 519-5227

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 002930 CT Primary

Addresses

Primary practice location

10 N Main St Ste 1
West Hartford, CT 06107-1968

Mailing address

14 Ridgewood Rd
West Hartford, CT 06107-2719
Phone (860) 519-5227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160922000490 CT Part B Supplier - Clinic/Group Practice 4385931195 Receives reassigned benefits from 6 practitioners
Practice locations: Danielson, CT; Windham, CT; West Hartford, CT; Waterford, CT; Putnam, CT; Meriden, CT; East Windsor, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468281600000",
    "number": "1669824702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 RIDGEWOOD RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072719",
            "telephone_number": "860-519-5227",
            "fax_number": "845-728-0667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N MAIN ST STE 1",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061071968",
            "telephone_number": "860-519-5227",
            "fax_number": "845-728-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN D OLIVEIRA PSY D LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-12",
        "status": "A",
        "authorized_official_last_name": "OLIVEIRA",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-519-5227",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "002930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; 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.