TABASSUM A ALI APRN NPI 1578819884

NPI Information

NPI: 1578819884
Provider Name: TABASSUM A ALI, APRN
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
141 E MAIN ST
WATERBURY CLINICIAL SERVICES 2ND FLOOR
WATERBURY, CT
ZIP 06702
Phone: (855) 935-5667
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Tabassum A Ali, APRN is a psychiatric/mental health nurse practitioner in Waterbury, CT. Tabassum A Ali, APRN NPI is 1578819884. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

141 E MAIN ST
WATERBURY CLINICIAL SERVICES 2ND FLOOR
WATERBURY, CT
ZIP 06702
Phone: (855) 935-5667
Fax: (203) 596-0722

The NPI 1578819884 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/24/2012 and was last updated on 3/7/2023.

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	163W00000X	Registered Nurse		98808	CONNECTICUT	No
2	163WP0807X	Registered Nurse	Psychiatric/Mental Health, Child & Adolescent	ANCC2012007952	CONNECTICUT	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	005035	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 BEHAVIORAL HEALTH NETWORK WELLMORE GRP/FACILITY
2	12671467	OTHER		CAQH
3	507335	OTHER	CONNECTICUT	MHN/MANAGED HEALTH NETWORK
4	CSP.0053391	OTHER	CONNECTICUT	CONTROLLED SUBSTANCE LICENSE
5	4853955	OTHER	CONNECTICUT	CIGNA BEHAVIORAL HEALTH
6	9777891	OTHER	CONNECTICUT	AETNA BEHAVIORAL HEALTH
7	060669107	OTHER	CONNECTICUT	HCT-HEALTHY CT WELLMORE GRP/FACILITY CONTRACT
8	060669107	OTHER	CONNECTICUT	UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
9	507335	OTHER	CONNECTICUT	TRICARE NORTH
10	060669107	OTHER	CONNECTICUT	ANTHEM BCBS OF CT BEHAVIORAL HEALTH-WELLMORE GRP/FACILITY
11	008042033	MEDICAID	CONNECTICUT
12	D339209 WATERBURY	OTHER	CONNECTICUT	VALUE OPTIONS/BEACON HEALTH STRATEGIES
13	060669107	OTHER	CONNECTICUT	UBH-OXFORD HEALTH/LIBERTY GRP/FACILITY
14	CSP.0053391	OTHER	CONNECTICUT	CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER

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: 4/28/2024

NPI Synchronization or Removal

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