Mandy Tiedeman, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2402 Issued in CT

Practice address

119C Griswold St Ste 202
Glastonbury, CT 06033-1099

Phone

(860) 918-7946

Fax

(860) 735-5842

NPI assigned

Sep 10, 2020

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 names 1

• Mandy Lynn Phillips Other name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Silver Linings Counseling, LLC

  • Marriage & Family Therapist
  • Danielson, CT
  • NPI 1013309996
  NPD (past)

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1891300539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119C GRISWOLD ST STE 202",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060331099",
            "telephone_number": "860-918-7946",
            "fax_number": "860-735-5842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119C GRISWOLD ST STE 202",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060331099",
            "telephone_number": "860-918-7946",
            "fax_number": "860-735-5842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 Main St",
            "address_purpose": "LOCATION",
            "city": "Danielson",
            "state": "CT",
            "postal_code": "062392816",
            "country_code": "US",
            "telephone_number": "860-774-2323",
            "fax_number": "860-831-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21 Middle Tpke E",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "CT",
            "postal_code": "060404249",
            "country_code": "US",
            "telephone_number": "860-774-2323",
            "fax_number": "860-831-1140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIEDEMAN",
        "first_name": "MANDY",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "2402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "PHILLIPS",
            "middle_name": "LYNN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Glastonbury, CT
• Marriage & Family Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.