| State Of Connecticut | |
|
401 West Thames Street Building 301 Norwich CT 06360 | |
| (860) 859-4674 | |
| (860) 859-4790 |
| Full Name | State Of Connecticut |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 West Thames Street, Norwich, Connecticut |
| Authorized Official Name and Position | Stephen A Dipietro (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8604186923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Connecticut 401 West Thames Street Building 301 Norwich CT 06360 Ph: (860) 859-4674 | State Of Connecticut 401 West Thames Street Building 301 Norwich CT 06360 Ph: (860) 859-4674 |
| NPI Number | 1902831548 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 03/16/2016 |
| Medicare PECOS PAC ID | 8022915677 |
|---|---|
| Medicare Enrollment ID | O20040319000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902831548 | NPI | - | NPPES |
| 004220307 | Medicaid | CT | |
| 004120200 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Denise E Boras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336200328 PECOS PAC ID: 5395646343 Enrollment ID: I20040114000318 |
| Provider Name | Cynthia Lheureux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033178926 PECOS PAC ID: 6204823693 Enrollment ID: I20040428000238 |
| Provider Name | Barclay G Caras |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346265592 PECOS PAC ID: 7012913510 Enrollment ID: I20061005000491 |
| Provider Name | Mary E Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780628636 PECOS PAC ID: 5496757320 Enrollment ID: I20070206000588 |
| Provider Name | Mary Jane King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679638993 PECOS PAC ID: 1355432519 Enrollment ID: I20070802000528 |
| Provider Name | Gina Higgins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114110160 PECOS PAC ID: 3577656503 Enrollment ID: I20070907000404 |
| Provider Name | Courtney M Malcolm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093909525 PECOS PAC ID: 8527138817 Enrollment ID: I20080529000187 |
| Provider Name | Patricia A Medling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851562219 PECOS PAC ID: 9436224722 Enrollment ID: I20080821000176 |
| Provider Name | Cynthia A Winer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215181870 PECOS PAC ID: 8628133600 Enrollment ID: I20090209000486 |
| Provider Name | Pamela J Dole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245444702 PECOS PAC ID: 3577655471 Enrollment ID: I20100712000732 |
| Provider Name | Lori D Orend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619031309 PECOS PAC ID: 7113116575 Enrollment ID: I20110115000087 |
| Provider Name | Stephanie A Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407154149 PECOS PAC ID: 7618152869 Enrollment ID: I20110503000457 |
| Provider Name | Cynthia L Mason Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356668040 PECOS PAC ID: 7810156775 Enrollment ID: I20120313000031 |
| Provider Name | Emmanuelle R Howe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205087053 PECOS PAC ID: 4284874496 Enrollment ID: I20130711000848 |
| Provider Name | Fanny E Aguilar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760733786 PECOS PAC ID: 6901047414 Enrollment ID: I20130725000845 |
| Provider Name | Gina M Velez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497176614 PECOS PAC ID: 0648409888 Enrollment ID: I20140210000988 |
| Provider Name | Michelle Caron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033531744 PECOS PAC ID: 9133346661 Enrollment ID: I20140807000228 |
| Provider Name | Harvey W Gemme |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295149649 PECOS PAC ID: 4486871563 Enrollment ID: I20140813001976 |
| Provider Name | Eric Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235534843 PECOS PAC ID: 8729307459 Enrollment ID: I20150501000291 |
| Provider Name | Paul E. Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083051684 PECOS PAC ID: 4486975018 Enrollment ID: I20150608000826 |
| Provider Name | Marie Louise Malboeuf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770844904 PECOS PAC ID: 5799080800 Enrollment ID: I20160229000556 |
| Provider Name | Chika J Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447599196 PECOS PAC ID: 8123318367 Enrollment ID: I20160601000331 |
| Provider Name | Alaina N Velasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386716561 PECOS PAC ID: 2264726074 Enrollment ID: I20160802001220 |
| Provider Name | Olufumilayo Agbaje |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447621230 PECOS PAC ID: 0749576163 Enrollment ID: I20160912001927 |
| Provider Name | Siobhan Ashley Gaston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295254340 PECOS PAC ID: 6800156167 Enrollment ID: I20180205002476 |
| Provider Name | Alma Rosa Barreto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114462751 PECOS PAC ID: 4789949801 Enrollment ID: I20180521000647 |
| Provider Name | Kathleen Susan Hull |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558840603 PECOS PAC ID: 7911258330 Enrollment ID: I20180925001668 |
| Provider Name | Lisa Cygan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134689714 PECOS PAC ID: 8729329719 Enrollment ID: I20190329002250 |
| Provider Name | Chanel Justice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609335397 PECOS PAC ID: 3678815982 Enrollment ID: I20190506002211 |
| Provider Name | Kaitlyn Occhionero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447813886 PECOS PAC ID: 1557604329 Enrollment ID: I20190517001014 |
| Provider Name | Joan Telemaque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619447935 PECOS PAC ID: 9234462649 Enrollment ID: I20190617002020 |
| Provider Name | Brian C Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598130437 PECOS PAC ID: 1658600499 Enrollment ID: I20190904002079 |
| Provider Name | Carleigh Glynn Hannah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851934947 PECOS PAC ID: 9739511817 Enrollment ID: I20191111001839 |
| Provider Name | Mary Kenny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760032023 PECOS PAC ID: 0648604033 Enrollment ID: I20191217002832 |
| Provider Name | Michelle Rossignol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780193185 PECOS PAC ID: 3870928641 Enrollment ID: I20200124001657 |
| Provider Name | Katherine Sara Reiners |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053710996 PECOS PAC ID: 1153749072 Enrollment ID: I20200909002264 |
| Provider Name | Shelley Beth Kingsbury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104462654 PECOS PAC ID: 3779993415 Enrollment ID: I20201108000000 |
| Provider Name | Ayanna K Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467911743 PECOS PAC ID: 4880008010 Enrollment ID: I20210130000025 |
| Provider Name | Kaila Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346816105 PECOS PAC ID: 9032519830 Enrollment ID: I20210616001257 |
| Provider Name | Erin Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780991117 PECOS PAC ID: 2466876636 Enrollment ID: I20211222002162 |
| Provider Name | Amy A Piersa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750892139 PECOS PAC ID: 6305237249 Enrollment ID: I20220103001082 |
| Provider Name | Bonita Byars |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639830581 PECOS PAC ID: 0749673069 Enrollment ID: I20220209002577 |
| Provider Name | Kelly Patricia Vanasse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912665050 PECOS PAC ID: 2163815150 Enrollment ID: I20220216000829 |
| Provider Name | Shannon Klock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992449649 PECOS PAC ID: 7315314671 Enrollment ID: I20221031001315 |
| Provider Name | Christina Mckenzie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386359826 PECOS PAC ID: 4587036249 Enrollment ID: I20230207002346 |
| Provider Name | Kristen Fernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881301711 PECOS PAC ID: 1153787239 Enrollment ID: I20230516000144 |
| Provider Name | Timothy Jean Schlehofer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679286413 PECOS PAC ID: 5799143467 Enrollment ID: I20230628001707 |
| Provider Name | Ellen Catherine Crichton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427607712 PECOS PAC ID: 1557710720 Enrollment ID: I20231213001534 |
| Provider Name | Mercury Ripley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770897043 PECOS PAC ID: 4789831413 Enrollment ID: I20240108000205 |
| Provider Name | Monica R Mobley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841811577 PECOS PAC ID: 6406208016 Enrollment ID: I20240119000551 |
| Provider Name | Yabneel Marrero-canales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275004012 PECOS PAC ID: 6608216742 Enrollment ID: I20240506004284 |
| Provider Name | Uzochukwu Ekpunobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174367304 PECOS PAC ID: 4183161177 Enrollment ID: I20240808001473 |
| Provider Name | Kristin Leigh Chabot |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1407192859 PECOS PAC ID: 4688114010 Enrollment ID: I20240911003476 |
| Provider Name | Kayla B Gero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366296154 PECOS PAC ID: 2163963000 Enrollment ID: I20240919001330 |
| Provider Name | Joseph R Labrecque |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427542976 PECOS PAC ID: 4284175134 Enrollment ID: I20240919001662 |
| Provider Name | Deval Raval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942958764 PECOS PAC ID: 4981138856 Enrollment ID: I20241114002445 |
Jeigh Hayes Health And Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 New London Tpke, Office 3, Suite A, Norwich, CT 06360 Phone: 860-857-8176 | |
Cedarwood Counseling, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 12 Case St Ste 202, Norwich, CT 06360 Phone: 860-303-3051 | |
Catholic Charities Diocese Of Norwich Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 331 Main St, Norwich, CT 06360 Phone: 860-889-8346 | |
Vwb Counseling, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 12 Case Street, Suite 302, Norwich, CT 06360 Phone: 860-984-3786 | |
Julie A Longton Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 20 Carver Ave, Norwich, CT 06360 Phone: 860-886-8233 | |
Therapeutic Matters Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 8 Mahan Dr, Norwich, CT 06360 Phone: 860-934-5123 | |
Carol Campbell Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 18 Oneco St, Suite 3, Norwich, CT 06360 Phone: 860-984-3190 |