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 | | 353 | 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 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 3 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 4 | NOT ELIGIBLE | MEDICARE PIN | CONNECTICUT | |
| 5 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 6 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 7 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITIY |
| 8 | 13803735 | OTHER | CONNECTICUT | CAQH |
| 9 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN TRICARENORTH |
| 10 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 11 | 060669107 | OTHER | CONNECTICUT | UBH-OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY |
| 12 | PENDING | MEDICAID | CONNECTICUT | |
| 13 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT- WELLMORE GRP/FACILITY |
