Jack Thaw, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001266 Issued in CT

Practice address

300 Hebron Ave
Suite 217 Counseling Affiliates Inc Medical Arts Center
Glastonbury, CT 06033

Phone

(860) 659-2697

Fax

(860) 659-3468

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Counseling Affiliates LLC

  • Psychologist
  • Glastonbury, CT
  • NPI 1760650519
  NPD (past) Authorized official

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801923586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE",
            "address_2": "SUITE 217 COUNSELING AFFILIATES INC MEDICAL ARTS CENTER",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "06033",
            "telephone_number": "860-659-2697",
            "fax_number": "860-659-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HEBRON AVE",
            "address_2": "SUITE 217 COUNSELING AFFILIATES INC MEDICAL ARTS CENTER",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "06033",
            "telephone_number": "860-659-2697",
            "fax_number": "860-659-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAW",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC",
            "identifier": "0600011266001",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2743373",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS UBH",
            "identifier": "134309",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magdalena Z Tauber, DMD
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• Jillian Quinn Taylor, LCSW
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• The Center for Children With Special Needs
• The Center for Children With Special Needs, LLC
• The Center for Geriatric and Family Psychiatry, Inc.
• The Foot Group, LLC
• The Hearing Center of Glastonbury

• Clinical Psychologist in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Clinical Psychologist in Connecticut

• 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.

Verify at the official NPI Registry.