Basic Information
| Provider Information | |||||||||
| NPI: | 1073882676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMPSON | ||||||||
| FirstName: | PARKER | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FARVIEW RD | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068041831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034704637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066103222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033379943 | ||||||||
| FaxNumber: | 2033379986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2011 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 001259 | CT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 001259 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 008038185 | 05 | CT | MEDICAID | 008042339 | 05 | CT | MEDICAID | 008023170 | 05 | CT | MEDICAID | 008024427 | 05 | CT | MEDICAID |