Active NPI
Thomas Martin Carlson, PSY.D.
- Clinical Psychologist
- Glastonbury, CT
National Provider Identifier
1760518344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 002229
- Practice address
- 300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176 - Phone
- (860) 657-8545
- Fax
- (860) 657-8482
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 002229 | CT | Primary |
Addresses
Primary practice location
300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176
Mailing address
300 Hebron Ave
Suite 215
Glastonbury, CT 06033-2176
Phone (860) 657-8545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 27, 2017 through Jul 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002229 | CT | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760518344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 HEBRON AVE",
"address_2": "SUITE 215",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332176",
"telephone_number": "860-657-8545",
"fax_number": "860-657-8482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 HEBRON AVE",
"address_2": "SUITE 215",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332176",
"telephone_number": "860-657-8545",
"fax_number": "860-657-8482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "THOMAS",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "002229",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.