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MISS MYA PETCHARK LADC
NPI 1144069840
Counselor - Addiction (Substance Use Disorder) in New London, CT

Active since May 22, 2024PECOS Enrolled
931 BANK ST, NEW LONDON, CT 06320(860) 574-8252 Get Directions Write a Review

NPPES record last updated: May 22, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Miss Mya Petchark Ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS MYA PETCHARK LADC (NPI 1144069840) is an individual addiction (substance use disorder) provider in New London, Connecticut, licensed in Connecticut (1565) and active in the NPI registry since May 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1144069840
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMISS MYA PETCHARKCredential: LADC
Location Address931 BANK STNew London, CT 06320-2702
Mailing Address359 Long Hill Rd Apt 22Groton, CT 06340-3842 · (860) 389-4630
Phone(860) 574-8252
Sole ProprietorYes
Enumeration DateMay 22, 2024
NPPES CertifiedMay 22, 2024
✔ NPI 1144069840 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in CT · 1565
931 BANK ST, New London, CT 06320
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miss Mya Petchark Ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mya Petchark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Hartford Dispensary
41 mi
Mental Health (Including Community Mental Health Center)
345 MAIN ST
Hartford, CT 06106
  • Reassigned Medicare billing, Connecticut enrollment
  • 50 clinicians in this Medicare group
NPI 1104949973 (860) 525-2181

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ANNETTE LICKWOLA LADC
Counselor (Addiction (Substance Use Disorder))
931 BANK ST
NEW LONDON, CT 06320
Southeastern Connecticut Planning Region (860) 574-8256
MRS. MARIE VARGO LCSW
Social Worker (Clinical)
931 BANK ST
NEW LONDON, CT 06320
Southeastern Connecticut Planning Region (860) 447-2233
SARA CYR LCSW
Social Worker (Clinical)
931 BANK ST
NEW LONDON, CT 06320
Southeastern Connecticut Planning Region (860) 447-2233
MS. BARBARA A GOTAY MATTHEW LADC
Counselor (Addiction (Substance Use Disorder))
931 BANK ST
NEW LONDON, CT 06320
Southeastern Connecticut Planning Region (860) 447-2233

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mya Petchark's NPI number?

The NPI number for Mya Petchark is 1144069840. It was assigned to this individual provider in the NPPES registry on May 22, 2024.

Where is Mya Petchark located?

Mya Petchark practices at 931 Bank St, New London, CT 06320. The listed phone number is (860) 574-8252.

What is Mya Petchark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Mya Petchark enrolled in Medicare?

Yes. Mya Petchark is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mya Petchark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mya Petchark reassigns Medicare benefits to Hartford Dispensary (Hartford, CT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mya Petchark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mya Petchark was last updated on May 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.