Individual provider Active NPI

Tegwyn Lacz

  • Marriage & Family Therapist
  • Norwich, CT
National Provider Identifier
1942687694
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2080 Issued in CT
Practice address
47 Town St
Norwich, CT 06360-2323
Phone
(860) 892-7042
NPI assigned
May 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 2080 CT Primary

Addresses

Primary practice location

47 Town St
Norwich, CT 06360-2323

Mailing address

823 Main St
Hope Valley, RI 02832-1920
Phone (401) 539-2461

Other practice location 1

225 N Main St
Bristol, CT 06010-4926
Phone (860) 508-8921

Other practice location 2

823 Main St
Hope Valley, RI 02832-1920
Phone (401) 539-2461

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240322003102 RI Practitioner - Marriage and Family Therapist 6709223969 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wood River Health Services, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

823 Main St
Hope Valley, RI 02832

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1942687694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 MAIN ST",
            "city": "HOPE VALLEY",
            "state": "RI",
            "postal_code": "028321920",
            "telephone_number": "401-539-2461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602323",
            "telephone_number": "860-892-7042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 N Main St",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "CT",
            "postal_code": "060104926",
            "country_code": "US",
            "telephone_number": "860-508-8921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "823 Main St",
            "address_purpose": "LOCATION",
            "city": "Hope Valley",
            "state": "RI",
            "postal_code": "028321920",
            "country_code": "US",
            "telephone_number": "401-539-2461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACZ",
        "first_name": "TEGWYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-01",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "2080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.