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 | C-0265 | CONNECTICUT | No |
| 2 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | SA-0190 | 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 | 001155787 | OTHER | CONNECTICUT | SHIMELMAN MEDICAID |
| 2 | 008071202 | OTHER | CONNECTICUT | MEDICAID AMYNAH DHARANI |
| 3 | 008066801 | OTHER | CONNECTICUT | HAQUE MEDICAID |
| 4 | 001307439 | OTHER | CONNECTICUT | ALTICE MEDICAID |
| 5 | D400357267 | MEDICARE PIN | CONNECTICUT | |
| 6 | D400363247 | MEDICARE PIN | CONNECTICUT | |
| 7 | D40076510 | MEDICARE PIN | CONNECTICUT | |
| 8 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 9 | 008040283 | OTHER | CONNECTICUT | CAMENGA MEDICAID |
| 10 | 008039605 | OTHER | CONNECTICUT | HERMES MEDICAID # |
| 11 | 008038040 | OTHER | CONNECTICUT | LENCZYCKI MEDICAID |
| 12 | 008038044 | OTHER | CONNECTICUT | FARNUM MEDICAID |
| 13 | D400356228 | MEDICARE PIN | CONNECTICUT | |
| 14 | 008064860 | OTHER | CONNECTICUT | WEISS MEDICAID |
| 15 | 008048733 | OTHER | CONNECTICUT | SUCHMAN MEDICAID |
| 16 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 17 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 18 | 008038036 | OTHER | CONNECTICUT | BAKER MEDICAID |
| 19 | 008038043 | OTHER | CONNECTICUT | WHELAN MEDICAID |
| 20 | 008042701 | OTHER | CONNECTICUT | KATZMAN MEDICAID |
| 21 | D400346532 | MEDICARE PIN | CONNECTICUT | |
| 22 | 001423136 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 23 | 440000058 | MEDICARE PIN | CONNECTICUT | |
| 24 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 25 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 26 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 27 | 008058058 | OTHER | CONNECTICUT | SADINSKY MEDICAID |
| 28 | 008001077 | OTHER | CONNECTICUT | MOORE MEDICAID |
| 29 | 008048372 | OTHER | CONNECTICUT | SHARMAIN MEDICAID |
| 30 | 008038741 | OTHER | CONNECTICUT | OWEN MEDICAID |
| 31 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 32 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 33 | 008069118 | OTHER | CONNECTICUT | CAMPBELL MEDICAID # |
| 34 | 008058728 | OTHER | CONNECTICUT | RIERA MEDICAID |
| 35 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 36 | 004041000 | OTHER | CONNECTICUT | ACCESS/MEDICAID/SA |
| 37 | 008003745 | OTHER | CONNECTICUT | DESROSIERS MEDICAID |
| 38 | D400372444 | MEDICARE PIN | CONNECTICUT | |
| 39 | D400132157 | MEDICARE PIN | CONNECTICUT | |
| 40 | 008038042 | OTHER | CONNECTICUT | POLANETSKA MEDICAID |
| 41 | D400365390 | MEDICARE PIN | CONNECTICUT | |
| 42 | D400318461 | MEDICARE PIN | CONNECTICUT | |
| 43 | D400358574 | MEDICARE PIN | CONNECTICUT | |
| 44 | D400357474 | MEDICARE PIN | CONNECTICUT | |
| 45 | 008063396 | OTHER | CONNECTICUT | MEMISEVICH MEDICAID |
| 46 | 008057135 | OTHER | CONNECTICUT | MEDICAID HEALTHER KNOX |
| 47 | 008057039 | OTHER | CONNECTICUT | MILLER'S MEDICAID |
| 48 | 008063217 | OTHER | CONNECTICUT | APPLEGET MEDICAID |
| 49 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 50 | 008048393 | OTHER | CONNECTICUT | BARRY MEDICAID |
