NPIMap

Organization Active NPI

Laurel Health Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hamden, CT
National Provider Identifier
1891716627
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
589570 Issued in CT
Legal business name
LAUREL HEALTH SERVICES, LLC
Practice address
295 Washington Ave
Suite 9
Hamden, CT 06518-3025
Phone
(203) 287-8227
Fax
(203) 287-9502
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Authorized official

Name
Dr. Jeffrey Warren Summerville, PSY.D., LCSWNPI 1013926708
Title
Partner
Phone
(203) 287-8227

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 589570 CT Primary

Addresses

Primary practice location

295 Washington Ave
Suite 9
Hamden, CT 06518-3025

Mailing address

295 Washington Ave
Suite 9
Hamden, CT 06518-3025
Phone (203) 287-8227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060926000158 CT Part B Supplier - Clinic/Group Practice 4284639261 Receives reassigned benefits from 3 practitioners
Practice locations: Hamden, CT

National Provider Directory

National Provider Directory

Locations

295 Washington Ave
Hamden, CT 06518
Phone (203) 288-8221

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1891716627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 WASHINGTON AVE",
            "address_2": "SUITE 9",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183025",
            "telephone_number": "203-287-8227",
            "fax_number": "203-287-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 WASHINGTON AVE",
            "address_2": "SUITE 9",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183025",
            "telephone_number": "203-287-8227",
            "fax_number": "203-287-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "SUMMERVILLE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "203-287-8227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "589570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.