NPIMap

Organization Active NPI

Hartford Psychological Services, LLC

  • Psychologist
  • Hartford, CT
National Provider Identifier
1891989026
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
103T00000X Issued in CT
Legal business name
HARTFORD PSYCHOLOGICAL SERVICES, LLC
Practice address
210 Wethersfield Ave
Hartford, CT 06114-1113
Phone
(860) 296-0094
Fax
(860) 206-1184
NPI assigned
Aug 30, 2007
Last updated
Jan 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Dr. Rafael Mora de Jesus, PH.D.NPI 1366503906
Title
Director
Phone
(860) 296-0094

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 103T00000X CT Primary
Clinical Social Worker 1041C0700X 1041C0700X CT

Addresses

Primary practice location

210 Wethersfield Ave
Hartford, CT 06114-1113

Mailing address

210 Wethersfield Ave
Hartford, CT 06114-1113
Phone (860) 296-0094

Other identifiers 1

IdentifierTypeStateIssuer
004222866MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141211001758 CT Part B Supplier - Clinic/Group Practice 6406178961 Receives reassigned benefits from 11 practitioners
Practice locations: Hartford, CT

National Provider Directory

National Provider Directory
Tax ID family
Hartford Psychological Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

191 Franklin Ave
Hartford, CT 06114
Phone (860) 296-7460

210 Wethersfield Ave
Hartford, CT 06114
Phone (860) 296-0094

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1891989026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WETHERSFIELD AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061141113",
            "telephone_number": "860-296-0094",
            "fax_number": "860-206-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WETHERSFIELD AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061141113",
            "telephone_number": "860-296-0094",
            "fax_number": "860-206-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARTFORD PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "MORA DE JESUS",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "860-296-0094",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "103T00000X",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "1041C0700X",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004222866",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.