Etherapy of Connecticut, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

006512 Issued in CT

Legal business name

ETHERAPY OF CONNECTICUT, LLC

Practice address

1062 Barnes Rd Ste 106
Wallingford, CT 06492-6012

Phone

(860) 882-3268

Fax

(203) 265-0165

NPI assigned

Aug 31, 2012

Organization subpart

No

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

Authorized official

Name

Justin Andrew Rogala, LCSWNPI 1205013315

Title

Owner & Provider

Phone

(203) 308-8739

Specialties & licenses 2

Addresses

Practitioners 1

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

• Justin Andrew Rogala, LCSW

  • Clinical Social Worker
  • New Haven, CT
  • NPI 1205013315
  NPD Authorized official

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1851640163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 DAMASCUS RD",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053961",
            "telephone_number": "860-882-3268",
            "fax_number": "203-265-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1062 BARNES RD STE 106",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064926012",
            "telephone_number": "860-882-3268",
            "fax_number": "203-265-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHERAPY OF CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROGALA",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER & PROVIDER",
        "authorized_official_telephone_number": "203-308-8739",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "CT",
            "license": "006512",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Equal Health Care LLC
• Wolf J Erlich, MD
• Lindsey Ertel, DPT
• Kristine Alexi Escobar, APRN
• Ryan Esposito
• Moira Ethier, MS
• Kelly Nicole Evanovich, PT, DPT, ATC
• Vanessa Joyce Matuod Evardone, M.D.
• Evolve Counseling & Consultationllc
• Eye & Vision Clinic

• Clinical Social Worker in Wallingford, CT
• Providers in Wallingford, 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 Jul 21, 2022; 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.