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 | | 122042 | CONNECTICUT | No |
| 2 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | 6582 | 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 | 13872963 | OTHER | CONNECTICUT | CAQH |
| 2 | CSP.0063703 | OTHER | CONNECTICUT | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTICIONER |
| 3 | PENDING | OTHER | CONNECTICUT | MANAGED HEALTH NETWORK/MHN |
| 4 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 5 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
| 6 | 060669107 | OTHER | CONNECTICUT | CONNECTICARE/UBH WELLMORE GRP/FACILITY |
| 7 | PENDING | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 8 | PENDING | OTHER | CONNECTICUT | MHN/TRICARENORTH |
| 9 | PMHNP-BC 2016011186 | OTHER | CONNECTICUT | COMMISSION ON CERTIFICATION ANCC-PSYCHIATRIC MENTAL HEALTH NURSE PRACCTIITIONER |
| 10 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 11 | 060669107 | OTHER | CONNECTICUT | UNITED HEALTHCARE/UBH WELLMORE GRP/FACILITY |
| 12 | 4887750 | OTHER | CONNECTICUT | CERTIFIED PSYCHIATRIC REHABILITIATION PRACTITIONER |
| 13 | PENDING | MEDICAID | CONNECTICUT | |
| 14 | 060669107 | OTHER | CONNECTICUT | ANTHEM BEHAVIORAL HEALTH GRP/FACILITY |
| 15 | 060669107 | OTHER | CONNECTICUT | LIBERTY/OXFORD FREEDOM PLANS/UBH WELLMORE GRP/FACILITY |
| 16 | D339123 WATERBURY | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
