Phouangmaly Phimvongsa, L.P.C

Primary specialty

CounselorTaxonomy code 101Y00000X

License

001470 Issued in CT

Practice address

82 Main St
Windsor Locks, CT 06096-2325

Phone

(860) 254-5127

Fax

(860) 310-4235

NPI assigned

Dec 5, 2006

Sex

Female

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 1

Other names 1

• Maly Phimvongsa Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Eastern Services & Camp Simon LLC

  • Professional Counselor
  • Windsor Locks, CT
  • NPI 1538582739
  NPD

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1821156498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 MAIN ST",
            "city": "WINDSOR LOCKS",
            "state": "CT",
            "postal_code": "060962325",
            "telephone_number": "860-254-5127",
            "fax_number": "860-310-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MAIN ST",
            "city": "WINDSOR LOCKS",
            "state": "CT",
            "postal_code": "060962325",
            "telephone_number": "860-254-5127",
            "fax_number": "860-310-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHIMVONGSA",
        "first_name": "PHOUANGMALY",
        "credential": "L.P.C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CT",
            "license": "001470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004257053",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALY",
            "last_name": "PHIMVONGSA",
            "credential": "LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brian Parsons, LMHC
• Hemali K Patel, PHARMD
• Maitri Patel, PHARM. D
• Peace, Hope and Wellness LLC
• Petite Fleur Nursing Center LLC
• Premier Transportation LLC
• Raytel Cardiac Services, Inc.
• Ride Care Network LLC
• Robert W. Zebrowski, D.M.D., L.L.C.
• Timothy Rodrigue

• All providers in Windsor Locks, CT
• Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.