NPI |
1538651179 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Entity Type Code |
2 |
The country code in the location address of the provider being identified. |
Employer Identification Number EIN |
|
The telephone number associated with the location address of the provider being identified. |
Provider Organization Name Legal Business Name |
WISDOM WITHIN COUNSELING LLC |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider First Line Business Practice Location Address |
461 MAIN ST |
The date that a record was last updated or changed. |
Provider Business Practice Location Address City Name |
NIANTIC |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address State Name |
CT |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Postal Code |
063573103 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8609841205 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
5/30/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
5/30/2018 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
ZISKIND |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
KATHERINE |
The first name of the authorized official. |
Authorized Official Middle Name |
L |
The middle name of the authorized official. |
Authorized Official Title or Position |
MARRIAGE AND FAMILY THERAPIST |
The title or position of the authorized official. |
Authorized Official Telephone Number |
8609841205 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
106H00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
001996 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
CT |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
MFT, RTY500, |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|