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 | 106H00000X | Marriage & Family Therapist | | 000692 | 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 | NOT ELIIGIBLE | MEDICARE PIN | CONNECTICUT | |
| 2 | 060669107 | OTHER | CONNECTICUT | UBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 3 | D339123 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES WELLMORE GRP/FACILITY |
| 4 | 193649 PENDING | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 5 | 008037445 | MEDICAID | CONNECTICUT | |
| 6 | 060669107 | OTHER | CONNECTICUT | UBH/CONNECTICARE WELLMORE GRP/FACILITY |
| 7 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 8 | 11244449 | OTHER | CONNECTICUT | CAQH |
| 9 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 10 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
| 11 | 060669107 | OTHER | CONNECTICUT | UBH/LIBERTY-FREEDOM WELLMORE GRP/FACILITY |
| 12 | 193649 | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 13 | 5307750 | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 14 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
