MICHAEL ANDREW WIDROFF (NPI# 1528433877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528433877 |
| Entity Type | Individual |
| Full Name | MICHAEL ANDREW WIDROFF |
| Practice Address |
1 Wahoo Ave Groton CT 06349-2324 |
| Mailing Address |
920 E 17th St Apartment 606 Brooklyn NY 11230-3751 |
| Practice Telephone | 8606944966 |
| Mailing Telephone | 9174020360 |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2018-04-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1 WAHOO AVE |
| City | GROTON |
| State | CT |
| Zip Code | 06349-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043207004 | Matthew Braden Burns Miller | Dentist | 1 Wahoo Ave, Groton, CT 06349 | 2005-10-04 |
| 1063027407 | Jimmy Nazih Suliman | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-09-12 |
| 1790395242 | Duc-nhan Nguyen Pham | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-08-08 |
| 1770112708 | Amanda Kathleen Dobyns | Occupational Therapist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-04-02 |
| 1831732825 | Cody Clark | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-10-22 |
| 1477103059 | Jordan Taylor Rucinski | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-09-16 |
| 1699335372 | Cynthia Daigneault | Counselor | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-06-16 |
| 1942868211 | Cameron Anson Martin | Military Health Care Provider | 1 Wahoo Ave, Groton, CT 06340 | 2019-06-03 |
| 1104386903 | Zena Sabath | General Practice | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-03-20 |
| 1538636527 | Winston Eugene Young | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2018-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434347 | Mvca | Optometrist | Navy Submarine Base New London, Bldg 484, Groton, CT 06349 | 2020-10-12 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1588127575 | Morgan Ross Jones | Student in an Organized Health Care Education/Training Program | Bx 159 Navsubase Nlon, Groton, CT 06349 | 2019-04-08 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1013264423 | Dennis Buenaventura Custodio | Military Health Care Provider | 69 Trout Ave, Naval Undersea Medical Institute, Groton, CT 06349 | 2012-08-06 |
| 1609013549 | Nicolas David Mendoza | Military Health Care Provider | Uss Hawaii (ssn 776), Fpo, AE 06349 | 2009-01-14 |
| 1881843084 | Mark Francis Jarvis | Military Health Care Provider | Nssc Nlon, Bldg 76, Groton, CT 06349 | 2008-09-11 |
| 1780882738 | Michael Nutt | Military Health Care Provider | Bldg 517 Taugtog Ave, Navsubscol, Groton, CT 06349 | 2007-07-10 |
| 1497811343 | Keith Benjamin Hoekman | Nurse Practitioner | 1 Wahoo Dr, Groton, CT 06349 | 2006-12-28 |
| 1881604163 | Christina E Toufexis | Pediatrics | 1 Wahoo Drive, Groton, CT 06349 | 2006-08-09 |
| Find all providers in zip 06349 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164054698 | American Center for Cognitive Behavioral Training and Treatment,llc | Psychologist | 351 Pitkin St Fl 17, East Hartford, CT 06108-6221 | 2020-02-12 |
| 1528555877 | Kinder Behavioral Health LLC | Psychologist | 37 Crane St, Fairfield, CT 06825-4316 | 2018-04-21 |
| 1396263166 | Charles D Gore Jr. | Psychologist | 87 Turkey Hill Rd S, Westport, CT 06880-6312 | 2017-08-31 |
| 1417472754 | Jamsine Ramirez | Psychologist | 208 Derby Ave, Orange, CT 06477-1317 | 2017-08-08 |
| 1710244017 | Mark Spellmann | Psychologist | 119 Ball Pond Rd, New Fairfield, CT 06812-4536 | 2012-04-12 |
| 1043547763 | Kim Marie O'donnell | Psychologist | 142 Elm St, Cheshire, CT 06410-2808 | 2009-11-17 |
| 1679740468 | Mary Megan Mccarron | Psychologist | 597 Naugatuck Ave, Cccd Academy, Milford, CT 06461-4060 | 2008-05-12 |
| 1043495310 | Leonard Louis Wysocki | Psychologist | 49 Finley Hill Rd, Marlborough, CT 06447-1003 | 2008-01-07 |
| 1023291499 | Annalise Lawler Caron | Psychologist | 1720 Post Rd E Ste 223, Westport, CT 06880-5643 | 2007-12-08 |
| 1235269721 | Bina Roginsky | Psychologist | 21 Hazel Ter, Suite B, Woodbridge, CT 06525-2209 | 2007-03-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.