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 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 038814 | CONNECTICUT | No |
| 2 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 038814 | 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 | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 2 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 3 | 258645 | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 4 | PENDING 258645 | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 5 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH-UBH WELLMORE GRP/FACILITY |
| 6 | 5743 | OTHER | CONNECTICUT | THE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY |
| 7 | D339210 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
| 8 | 008037450 | MEDICAID | CONNECTICUT | |
| 9 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 10 | 060669107 | OTHER | CONNECTICUT | UBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY |
| 11 | 060669107 | OTHER | CONNECTICUT | UBH- CONNECTICARE WELLMORE GRP/FACILITY |
| 12 | 10450310 | OTHER | CONNECTICUT | CAQH |
| 13 | CSP.0037843 | OTHER | CONNECTICUT | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| 14 | 2155452 | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 15 | 7517308 | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
