Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | 006839 | CONNECTICUT | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 2 | 008030411 | MEDICAID | CONNECTICUT | |
| 3 | 12207576 | OTHER | CONNECTICUT | CAQH |
| 4 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 5 | PENDING | OTHER | CONNECTICUT | MHN |
| 6 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 7 | PENDING | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 8 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 9 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 10 | 060669107 | OTHER | CONNECTICUT | UBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY |
| 11 | D339123 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH |
| 12 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 13 | PENDING | MEDICARE PIN | CONNECTICUT | |
| 14 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
