Phoenix Recovery, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PHOENIX RECOVERY, LLC

Practice address

4270 Main St Ste 200
Bridgeport, CT 06606-2306

Phone

(203) 243-6170

NPI assigned

Jun 26, 2019

Organization subpart

No

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

Authorized official

Name

Amond Kenyutta Tillman, LADC

Title

Substance Abuse Therapist

Phone

(203) 243-6170

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1861053183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MARIE DR APT 12",
            "city": "SEYMOUR",
            "state": "CT",
            "postal_code": "064833665",
            "telephone_number": "203-243-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4270 MAIN ST STE 200",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066062306",
            "telephone_number": "203-243-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-26",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "AMOND",
        "authorized_official_middle_name": "KENYUTTA",
        "authorized_official_title_or_position": "SUBSTANCE ABUSE THERAPIST",
        "authorized_official_telephone_number": "203-243-6170",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008087099",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip a Micalizzi, Jr. M.D. PC
• Jisha Philip, M.D
• Jyothy Philipose, APRN
• Nicole J. Phillips, DNP
• Taylor Phillips, PA-C
• Phenyo Victor Phuu, M.D.
• Physical Medicine & Rehab Services LLC
• Victoria Piacquadio, CRNA
• Paul Joseph Piazza
• Christopher William Piccione, PA

• Addiction (Substance Use Disorder) Counselor in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.