STAYWELL HEALTH CARE INC. NPI 1477999340

NPI Information

NPI: 1477999340
Provider Name: STAYWELL HEALTH CARE INC.
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1309 S MAIN ST
WATERBURY, CT
ZIP 06706
Phone: (203) 597-9044
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STAYWELL HEALTH CARE INC. is a mental health (including community mental health center) clinic center in Waterbury, CT. STAYWELL HEALTH CARE INC. NPI is 1477999340. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1309 S MAIN ST
WATERBURY, CT
ZIP 06706-758
Phone: (203) 597-9044
Fax: (203) 596-9038

The provider's authorized official is Alexis Estrada .
The authorized official title is Credentialing Administrator and has the following contact phone number (203) 756-8021.

The enumeration date for this NPI number is 5/17/2013 and was last updated on 2/8/2018.

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	1041C0700X	Social Worker	Clinical	0506	CONNECTICUT	No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	0474	CONNECTICUT	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	0479	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	004235968	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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