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 | 9336 | 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 | HEALTHYCT WELLMORE GRP/FACILITY |
| 2 | PENDING | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 3 | 008064941 | MEDICAID | CONNECTICUT | |
| 4 | 060669107 | OTHER | CONNECTICUT | UBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY |
| 5 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 6 | 13671479 | OTHER | CONNECTICUT | CAQH |
| 7 | PENDING | MEDICARE PIN | CONNECTICUT | |
| 8 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 9 | TORRINGTON D339230 | OTHER | CONNECTICUT | BEACON HEALTH |
| 10 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 11 | PENDING | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 12 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 13 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 14 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
