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 | 104100000X | Social Worker | | 1644 | CONNECTICUT | No |
| 2 | 1041C0700X | Social Worker | Clinical | 009856 | 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 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 2 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT- WELLMORE GRP/FACILITY |
| 3 | PENDING | OTHER | CONNECTICUT | CAQH |
| 4 | PENDING | MEDICAID | CONNECTICUT | |
| 5 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH/OXFORD/LIBERTY-WELLMORE GRP/FACILITY |
| 6 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN MANAGE HEALTH NETWORK |
| 7 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH-CONNECTICARE/WELLMORE-GRP/FACILITY |
| 8 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT-WELLMORE, INC GROUP/FACILITY |
| 9 | D339209 | OTHER | CONNECTICUT | VALUE OPTIONS |
| 10 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN-TRICARE NORTH |
| 11 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 12 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH-UNITED HEALTHCARE/WELLMORE GRP/FACILITY |
