WELLMORE INC NPI 1962760561

NPI Information

NPI: 1962760561
Provider Name: WELLMORE, INC

Doing Business As: WELLMORE, INC.-WATERBURY OP BEHAVIORAL HEALTH SERVICES

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
402 EAST MAIN ST
WATERBURY OUTPATIENT BEHAVIORAL HEALTH SERVICES
WATERBURY, CT
ZIP 06702
Phone: (203) 755-1143
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WELLMORE, INC is a mental health (including community mental health center) clinic center in Waterbury, CT. WELLMORE, INC NPI is 1962760561. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellmore, Inc.-waterbury Op Behavioral Health Services.

The provider's business location address is:

402 EAST MAIN ST
WATERBURY OUTPATIENT BEHAVIORAL HEALTH SERVICES
WATERBURY, CT
ZIP 06702-701
Phone: (203) 755-1143
Fax: (203) 753-3274

The provider's authorized official is Gary M Steck .
The authorized official title is Chief Executive Officer and has the following contact phone number (203) 574-9000.

The CLIA number assigned to this NPI record is 07D2111489 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2012 and was last updated on 8/23/2016.

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

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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