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 | 163W00000X | Registered Nurse | | 98808 | CONNECTICUT | No |
| 2 | 163WP0807X | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | ANCC2012007952 | CONNECTICUT | No |
| 3 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | 005035 | 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 | UBH-UNITED BEHAVIORAL HEALTH NETWORK WELLMORE GRP/FACILITY |
| 2 | 12671467 | OTHER | | CAQH |
| 3 | 507335 | OTHER | CONNECTICUT | MHN/MANAGED HEALTH NETWORK |
| 4 | CSP.0053391 | OTHER | CONNECTICUT | CONTROLLED SUBSTANCE LICENSE |
| 5 | 4853955 | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 6 | 9777891 | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 7 | 060669107 | OTHER | CONNECTICUT | HCT-HEALTHY CT WELLMORE GRP/FACILITY CONTRACT |
| 8 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 9 | 507335 | OTHER | CONNECTICUT | TRICARE NORTH |
| 10 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT BEHAVIORAL HEALTH-WELLMORE GRP/FACILITY |
| 11 | 008042033 | MEDICAID | CONNECTICUT | |
| 12 | D339209 WATERBURY | OTHER | CONNECTICUT | VALUE OPTIONS/BEACON HEALTH STRATEGIES |
| 13 | 060669107 | OTHER | CONNECTICUT | UBH-OXFORD HEALTH/LIBERTY GRP/FACILITY |
| 14 | CSP.0053391 | OTHER | CONNECTICUT | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
