1114916574 NPI number — MS. LISA A TAYLOR-AUSTIN NCC, LPC, LMHC, CFMH

Table of content: MR. ROBERT DREW OTTEN LAADC, M-RAS, CSC (NPI 1447387345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114916574 NPI number — MS. LISA A TAYLOR-AUSTIN NCC, LPC, LMHC, CFMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR-AUSTIN
Provider First Name:
LISA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NCC, LPC, LMHC, CFMH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114916574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 BOSTON POST RD STE 3-1118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-2578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-522-6164
Provider Business Mailing Address Fax Number:
855-855-1870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 PLAINS RD
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06461-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-522-6164
Provider Business Practice Location Address Fax Number:
855-855-1870
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0019290 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1282 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008069396981 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 291145000 . This is a "MAGELLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 108346 . This is a "UBH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240001282CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 264405 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9000227085 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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