Active NPI
Mark Wickham, MT-BC
- Music Therapist
- Southington, CT
National Provider Identifier
1972480846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Music Therapist
- License
- 78
- Practice address
- 196 Queen St
Southington, CT 06489-1901 - Phone
- (860) 518-5777
- NPI assigned
- Aug 20, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Music Therapist | 225A00000X | 78 | CT | Primary |
Addresses
Primary practice location
196 Queen St
Southington, CT 06489-1901
Mailing address
196 Queen St
Southington, CT 06489-1901
Phone (860) 518-5777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78 | CT | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755648000000",
"number": "1972480846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "196 QUEEN ST",
"city": "SOUTHINGTON",
"state": "CT",
"postal_code": "064891901",
"telephone_number": "860-518-5777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "196 QUEEN ST",
"city": "SOUTHINGTON",
"state": "CT",
"postal_code": "064891901",
"telephone_number": "860-518-5777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKHAM",
"first_name": "MARK",
"credential": "MT-BC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-20",
"last_updated": "2025-08-20",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "CT",
"license": "78",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.