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LIFESOURCE OF NORTH CAROLINA
NPI 1972131308
Social Worker - Clinical in Bloomfield, CT

Active since March 31, 2020
140 PARK AVE, BLOOMFIELD, CT 06002(910) 742-9243(888) 746-1787 Get Directions Write a Review

NPPES record last updated: March 26, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 26, 2021, Mar 31, 2020 (2 updates tracked since 2020).

About Lifesource Of North Carolina NPPES

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

LIFESOURCE OF NORTH CAROLINA (NPI 1972131308) is a healthcare organization registered as a clinical in Bloomfield, Connecticut and active in the NPI registry since March 2020. The organization lists Peggy Baddour, President, as its authorized official.

NPPES Registry Identity

NPI1972131308
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameLIFESOURCE OF NORTH CAROLINA
Location Address140 PARK AVEBloomfield, CT 06002-3207
Mailing AddressPo Box 538622Atlanta, GA 30353-8622 · (910) 742-9243 · Fax (888) 746-1787
Phone(910) 742-9243
Fax(888) 746-1787
Organization SubpartNo
Authorized OfficialPeggy BaddourPresident · (910) 777-9165
Enumeration DateMarch 31, 2020
Last NPPES UpdateMarch 26, 20212 updates tracked since enumeration
NPPES CertifiedMarch 26, 2021
✔ NPI 1972131308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
140 PARK AVE, Bloomfield, CT 06002
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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

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.

MISS SYLWIA TUESTA AGPCNP-BC
Nurse Practitioner
140 PARK AVE
BLOOMFIELD, CT 06002
Capitol Planning Region (860) 243-9591
SASHA GRAHAM-GIVANS APRN
Nurse Practitioner (Psychiatric/Mental Health)
140 PARK AVE
BLOOMFIELD, CT 06002
Capitol Planning Region (860) 284-0182
DR. MICHAEL THOMAS SHEPPARD MD
Physical Medicine & Rehabilitation
140 PARK AVE
BLOOMFIELD, CT 06002
Capitol Planning Region (872) 231-3162
WINTONBURY CARE CENTER LLC
Skilled Nursing Facility
140 PARK AVE
BLOOMFIELD, CT 06002
Capitol Planning Region (860) 243-9591

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 Lifesource Of North Carolina's NPI number?

The NPI number for Lifesource Of North Carolina is 1972131308. It was assigned to this organization in the NPPES registry on March 31, 2020.

Where is Lifesource Of North Carolina located?

Lifesource Of North Carolina is located at 140 Park Ave, Bloomfield, CT 06002. The listed phone number is (910) 742-9243.

What is Lifesource Of North Carolina's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Lifesource Of North Carolina was last updated on March 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.