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 | 261QM0850X | Clinic/Center | Adult Mental Health | 0477 | 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 | 008038049 | OTHER | CONNECTICUT | PETHO MEDICAID |
| 2 | 008038019 | OTHER | CONNECTICUT | MEDICAID ONOFRIO |
| 3 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 4 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 5 | 008022626 | OTHER | CONNECTICUT | ORC/MEDICAID/MH |
| 6 | D400360105 | MEDICARE PIN | CONNECTICUT | |
| 7 | 008058217 | OTHER | CONNECTICUT | SEARS MEDICAID |
| 8 | D400076510 | MEDICARE PIN | CONNECTICUT | |
| 9 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 10 | D400356784 | MEDICARE PIN | CONNECTICUT | |
| 11 | 008066315 | OTHER | CONNECTICUT | COLON RIVERA MEDICAID |
| 12 | 008043611 | OTHER | CONNECTICUT | ROSS MEDICAID |
| 13 | 008061077 | OTHER | CONNECTICUT | VOLLONO MEDICAID |
| 14 | 004235083 | OTHER | CONNECTICUT | YOUNG MEDICAID |
| 15 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 16 | D400318773 | MEDICARE PIN | CONNECTICUT | |
| 17 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 18 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 19 | 008066551 | OTHER | CONNECTICUT | DEOLIVEIRA MEDICAID |
| 20 | 008050283 | OTHER | CONNECTICUT | HAYNES MEDICAID |
| 21 | 008053715 | OTHER | CONNECTICUT | NUNLEY MEDICAID |
| 22 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 23 | 008003745 | OTHER | CONNECTICUT | DESROSIERS MEDICAID |
| 24 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 25 | 008064634 | OTHER | CONNECTICUT | GARERI MEDICAID |
| 26 | 001423136 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 27 | D400357718 | MEDICARE PIN | CONNECTICUT | |
| 28 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 29 | 008038047 | OTHER | CONNECTICUT | DIMEOLA MEDICAID |
| 30 | D400083844 | MEDICARE PIN | CONNECTICUT | |
