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 | 104100000X | Social Worker | | 1398 | 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 | CIGNA BEHAVIORAL HEALTH |
| 2 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
| 3 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 4 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 5 | NOT ELIGIBLE | MEDICARE PIN | CONNECTICUT | |
| 6 | 13559879 | OTHER | CONNECTICUT | CAQH |
| 7 | 008060546 | MEDICAID | CONNECTICUT | |
| 8 | 060669017 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 9 | 060669107 | OTHER | CONNECTICUT | UBH OXFORD HEALTH FREEDOM/LIBERTY WELLMORE GRP/FACILITY |
| 10 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 11 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 12 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 13 | D339209 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
| 14 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
