Phetsamon Dilullo

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

010163 Issued in CT

Practice address

32 Maple Ave
Windsor, CT 06095-2922

Phone

(860) 973-9171

NPI assigned

Jan 27, 2019

Reactivated

Apr 12, 2019

Last updated

Apr 12, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CT, MA2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Amherst Psychotherapy Practice PCGroup PAC ID 6901231018, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Amherst Psychotherapy Practice PC

  dba Advance Psychotherapy Practice PC

  • Mental Health Counselor
  • Amherst, MA
  • NPI 1134760812

  Clinical

  Medicare reassignment Care Compare group NPD
• Community Health Resources, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Windsor, CT
  • NPI 1215979810
  Medicare reassignment NPD
• Connecticut Therapeutic Counseling LLC

  • Clinical Social Worker
  • Windsor, CT
  • NPI 1811453269
  NPD Authorized official
• Phetsamon Dilullo

  dba Connecticut Therapeutic Counseling LLC

  • Community/Behavioral Health Agency
  • Hartford, CT
  • NPI 1679031140
  NPD Authorized official

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

{
    "created_epoch": "1548547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555027200000",
    "number": "1982168688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MAPLE AVE",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952922",
            "telephone_number": "860-973-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 MAPLE AVE",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952922",
            "telephone_number": "860-973-9171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32 Maple Ave",
            "address_purpose": "LOCATION",
            "city": "Windsor",
            "state": "CT",
            "postal_code": "060952922",
            "country_code": "US",
            "telephone_number": "860-973-9171 x1",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DILULLO",
        "first_name": "PHETSAMON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-27",
        "last_updated": "2019-04-12",
        "deactivation_date": "2019-02-11",
        "reactivation_date": "2019-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "010163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Thomas Desrocher
• Nikita Dey
• Adriana Nicole Diaz
• Jayliany Jelia Diaz
• Ethan Ryan Dickinson, DPT
• Kelli Dimauro
• Christine Ann Dirienzo, MS CCC-A
• Divine Home Care LLC
• Lawi Djuma
• DND Group of Companies LLC

• Clinical Social Worker in Windsor, CT
• Providers in Windsor, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.