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 | 104100000X | Social Worker | | 2218 | CONNECTICUT | No |
| 2 | 1041C0700X | Social Worker | Clinical | | | 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 | 13671806 | OTHER | CONNECTICUT | CAQH |
| 2 | PENDING | MEDICAID | CONNECTICUT | |
| 3 | 060669107 | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| 4 | 060669107 | OTHER | CONNECTICUT | ANTHEM BEHAVIORRAL HEALTH WELLMORE GRP/FACILITY |
| 5 | 060669107 | OTHER | CONNECTICUT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 6 | NOT ELIGIBLE | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
| 7 | 060669107 | OTHER | CONNECTICUT | UBH-OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY |
| 8 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN-MANAGED HEALTH NETWORK |
| 9 | 060669107 | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 10 | NOT ELIGIBLE | OTHER | CONNECTICUT | MHN TRICARE NORTH |
| 11 | PENDING | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 12 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 13 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
