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 | 9019 | 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 | PENDING | OTHER | CONNECTICUT | MHN NETWORK MANAGE HEALTH NETWORK |
| 2 | 008060712 | MEDICAID | CONNECTICUT | |
| 3 | D339225-PINE ST | OTHER | CONNECTICUT | VALUE OPTIONS |
| 4 | 060669107 | OTHER | CONNECTICUT | UBH-OXFORD HEALTH/FREEDOM/LIBERTY WELLMORE GRP/FACILITY |
| 5 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE |
| 6 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 7 | 13671709 | OTHER | CONNECTICUT | CAQH |
| 8 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 9 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 10 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 11 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 12 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 13 | PENDING | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 14 | PENDING | MEDICARE PIN | CONNECTICUT | |
