| Hockanum Valley Community Council, Inc. | |
|
27 Naek Rd Suite 4 Vernon CT 06066-3965 | |
| (860) 872-9825 | |
| (860) 870-9384 |
| Full Name | Hockanum Valley Community Council, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 27 Naek Rd, Vernon, Connecticut |
| Authorized Official Name and Position | Celia Wheeler (OFFICE MANAGER) |
| Authorized Official Contact | 8608729825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hockanum Valley Community Council, Inc. 27 Naek Rd Suite 4 Vernon CT 06066-3965 Ph: (860) 872-9825 | Hockanum Valley Community Council, Inc. 27 Naek Rd Suite 4 Vernon CT 06066-3965 Ph: (860) 872-9825 |
| NPI Number | 1336179480 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 06/20/2022 |
| Certification Date | 06/20/2022 |
| Medicare PECOS PAC ID | 3476534017 |
|---|---|
| Medicare Enrollment ID | O20040601000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336179480 | NPI | - | NPPES |
| C01720 | Other | CT | MEDICARE GROUP |
| 004140498 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0466 (Connecticut) | Primary |
| Provider Name | Leela Panoor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609802388 PECOS PAC ID: 3577454198 Enrollment ID: I20040323001104 |
| Provider Name | Salvatore Iacobello |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225128333 PECOS PAC ID: 1052338183 Enrollment ID: I20051028000144 |
| Provider Name | Gilda M Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881706844 PECOS PAC ID: 8426006719 Enrollment ID: I20061031000043 |
| Provider Name | Craig Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023181534 PECOS PAC ID: 0244231223 Enrollment ID: I20070117000296 |
| Provider Name | Robert Goodwin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215051164 PECOS PAC ID: 8527157395 Enrollment ID: I20071130000457 |
| Provider Name | Theresa P Ouellette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063823839 PECOS PAC ID: 9537384813 Enrollment ID: I20140630000050 |
| Provider Name | Amy Destro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720572381 PECOS PAC ID: 3274881107 Enrollment ID: I20180808002494 |
| Provider Name | Christina R Mclaughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477027191 PECOS PAC ID: 8628316403 Enrollment ID: I20190221001005 |
| Provider Name | Jessica Pozzato |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205563970 PECOS PAC ID: 5890137996 Enrollment ID: I20240521002016 |
| Provider Name | John H Murphy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174749683 PECOS PAC ID: 6901114834 Enrollment ID: I20240601000054 |
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