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 | 101YP2500X | Counselor | Professional | 2747 | 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 | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 2 | 060669107 | OTHER | CONNECTICUT | ANTHEM BC BS OF CT WELLMORE GRP/FACILITY |
| 3 | PENDING | OTHER | CONNECTICUT | MANAGED HEALTH NETWORK |
| 4 | 008058806 | MEDICAID | CONNECTICUT | |
| 5 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 6 | 060669107 | OTHER | CONNECTICUT | UBH-LIBERTY/FREEDOM OXFORD HEALTH WELLMORE GRP/FACILITY |
| 7 | 13549351 | OTHER | CONNECTICUT | CAQH |
| 8 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 9 | NOT ELIGIBLE | MEDICARE PIN | CONNECTICUT | |
| 10 | PENDING | OTHER | CONNECTICUT | MHN TRICARE NORTH |
| 11 | 060669107 | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 12 | 060669107 | OTHER | CONNECTICUT | UBH- CONNECTICARE WELLMORE GRP/FACILITY |
| 13 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 14 | D339210 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
