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 | 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 | 008069118 | OTHER | CONNECTICUT | CAMPBELL MEDICAID # |
| 3 | 008064860 | OTHER | CONNECTICUT | WEISS MEDICAID |
| 4 | 008038741 | OTHER | CONNECTICUT | OWEN MEDICAID |
| 5 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 6 | 008038043 | OTHER | CONNECTICUT | WHELAN MEDICAID |
| 7 | D40076510 | MEDICARE PIN | CONNECTICUT | |
| 8 | 008063217 | OTHER | CONNECTICUT | APPLEGET MEDICAID |
| 9 | 008039605 | OTHER | CONNECTICUT | HERMES MEDICAID # |
| 10 | 001307439 | OTHER | CONNECTICUT | ALTICE MEDICAID |
| 11 | 008001077 | OTHER | CONNECTICUT | MOORE MEDICAID |
| 12 | 008042701 | OTHER | CONNECTICUT | KATZMAN MEDICAID |
| 13 | 008038040 | OTHER | CONNECTICUT | LENCZYCKI MEDICAID |
| 14 | D400357474 | MEDICARE PIN | CONNECTICUT | |
| 15 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 16 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 17 | 008066801 | OTHER | CONNECTICUT | HAQUE MEDICAID |
| 18 | 008058728 | OTHER | CONNECTICUT | RIERA TIMOTHY MEDICAID |
| 19 | 008058058 | OTHER | CONNECTICUT | SADINSKY MEDICAID |
| 20 | 008009745 | OTHER | CONNECTICUT | DESROSIERS MEDICAID |
| 21 | D400346532 | MEDICARE PIN | CONNECTICUT | |
| 22 | D400318461 | MEDICARE PIN | CONNECTICUT | |
| 23 | 008048372 | OTHER | CONNECTICUT | SHARMAIN MEDICAID |
| 24 | D400357267 | MEDICARE PIN | CONNECTICUT | |
| 25 | 008057039 | OTHER | CONNECTICUT | MILLER MEDICAID |
| 26 | 001423136 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 27 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 28 | D400363247 | MEDICARE PIN | CONNECTICUT | |
| 29 | 008048393 | OTHER | CONNECTICUT | BARRY MEDICAID |
| 30 | 008040283 | OTHER | CONNECTICUT | CAMENGA MEDICAID |
| 31 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 32 | 008038036 | OTHER | CONNECTICUT | BAKER MEDICAID |
| 33 | D400365390 | MEDICARE PIN | CONNECTICUT | |
| 34 | D400372444 | MEDICARE PIN | CONNECTICUT | |
| 35 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 36 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 37 | 008038042 | OTHER | CONNECTICUT | POLANETSKA MEDICAID |
| 38 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 39 | 008048733 | OTHER | CONNECTICUT | SUCHMAN MEDICAID |
| 40 | 004041000 | OTHER | CONNECTICUT | ASCESS/MEDICAID/MH |
| 41 | D400356228 | MEDICARE PIN | CONNECTICUT | |
| 42 | D400358574 | MEDICARE PIN | CONNECTICUT | |
| 43 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 44 | 440000058 | MEDICARE PIN | CONNECTICUT | |
| 45 | 008071202 | OTHER | CONNECTICUT | MEDICAID AMYNAH DHARANI |
| 46 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 47 | 008038044 | OTHER | CONNECTICUT | FARNUM MEDICAID |
| 48 | D400132157 | MEDICARE PIN | CONNECTICUT | |
