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 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 042611 | 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 | 10450310 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
| 2 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTH CARE WELLMORE GRP/FACILITY |
| 3 | 3495823 WELLMORE | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 4 | 060669107 | OTHER | CONNECTICUT | UBH- OXFORD LIBERTY/FREEDOM WELLMORE GRP/FACILITY |
| 5 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT -WELLMORE GRP/FACILITY |
| 6 | 390269 WELLMORE | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 7 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 8 | 9413737 WELLMORE | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 9 | 11726136 | OTHER | CONNECTICUT | CAQH |
| 10 | APBN-56223 | OTHER | CONNECTICUT | AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY-PSYCHIATRY |
| 11 | APBN6957 | OTHER | CONNECTICUT | AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY -CHILD AND ADOLESCENT PSYCHIATRY |
| 12 | 008037443 | MEDICAID | CONNECTICUT | |
| 13 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH- UBH WELLMORE GRP/FACILITY |
| 14 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 15 | 390269 INACTIVE | OTHER | CONNECTICUT | MHN TRICARE NORTH |
| 16 | CSP.0042193 | OTHER | CONNECTICUT | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
