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 | 101YP2500X | Counselor | Professional | 2424 | 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 | 060669107 | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
| 2 | 13540255 | OTHER | CONNECTICUT | CAQH |
| 3 | 5426745 | OTHER | CONNECTICUT | AETNA BEHAVIORAL HEALTH |
| 4 | 060669107 | OTHER | CONNECTICUT | UBH/ OXFORD FREEDOM-LIBERTY WELLMORE GRP/FACILITY |
| 5 | 539532 | OTHER | CONNECTICUT | MHN MANAGED HEALTH NETWORK |
| 6 | 008049735 | MEDICAID | CONNECTICUT | |
| 7 | 060669107 | OTHER | CONNECTICUT | HEALTHYCT WELLMORE GRP/FACILITY |
| 8 | 539532 | OTHER | CONNECTICUT | MHN/TRICARENORTH |
| 9 | NOT ELIGIBLE | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 10 | 060669107 | OTHER | CONNECTICUT | UBH/CONNECTICARE WELLMORE GRP/FACILITY |
| 11 | NOT ELIGIBLE | MEDICARE PIN | CONNECTICUT | |
| 12 | 060669107 | OTHER | CONNECTICUT | UBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| 13 | 060669107 | OTHER | CONNECTICUT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 14 | 14205 GROUP | OTHER | CONNECTICUT | BECON HEALTH STRATEGIES |
