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 | 183700000X | Pharmacy Technician | | PTN.0011947 | CONNECTICUT | No |
| 2 | 1041C0700X | Social Worker | Clinical | 9267 | CONNECTICUT | Yes |
| 3 | 1041C0700X | Social Worker | Clinical | | | No |
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 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 2 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 3 | 008060347 | MEDICAID | CONNECTICUT | |
| 4 | 060669107 | OTHER | CONNECTICUT | UBH OXFORD/FREEDOM/LIBERTY WELLMORE GRP/FACILITY |
| 5 | PENDING | OTHER | CONNECTICUT | MHN TRICARE NORTH |
| 6 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 7 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 8 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 9 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 10 | D339209 | OTHER | CONNECTICUT | VALUE OPTIONS/BEACON HEALTH STRATEGIES |
| 11 | 13559521 | OTHER | CONNECTICUT | CAQH |
| 12 | PENDING | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
