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 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | DPH 0436/0528 | 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 | GRP/FACILITY | OTHER | CONNECTICUT | OPTUM BEHAVIORAL HEALTH/UBH |
| 2 | GRP/FACILITY | OTHER | CONNECTICUT | UBH/OXFORD-FREEDOM HEALTH |
| 3 | 008040528 | MEDICAID | CONNECTICUT | |
| 4 | GRP/FACILITY | OTHER | CONNECTICUT | HEALTHYCT |
| 5 | D339210 | OTHER | CONNECTICUT | BEACON HEALTH STRATEGIES |
| 6 | 7882859 | OTHER | CONNECTICUT | AETNA HEALTH PLAN |
| 7 | GRP/FACILITY | OTHER | CONNECTICUT | ANTHEM BCBS OF CT |
| 8 | LICENSE NO. 0436 | OTHER | CONNECTICUT | DPH-FACILITY FOR THE CARE OR TREATMENT OF SUBSTANCE ABUSE OR DEPENDENT PERSONS |
| 9 | D10077031 | MEDICARE PIN | CONNECTICUT | |
| 10 | 0528 | OTHER | CONNECTICUT | DPH-PSYCHIATRIC OUTPATIENT CLINIC FOR ADULTS |
| 11 | 2266871 | OTHER | CONNECTICUT | CIGNA BEHAVIORAL HEALTH |
| 12 | GRP/FACILITY | OTHER | CONNECTICUT | MHN/MHN TRICARE NORTH |
| 13 | GRP/FACILITY | OTHER | CONNECTICUT | UNITED BEHAVIORAL HEALTH |
| 14 | GRP/FACILITY | OTHER | CONNECTICUT | UBH-UNITED HEALTHCARE |
| 15 | GRP/FACILITY | OTHER | CONNECTICUT | UBH-CONNECTICARE |
