| Wellmore, Inc. | |
|
141 E Main St Waterbury CT 06702-2310 | |
| (203) 756-7287 | |
| (203) 596-0722 |
| Full Name | Wellmore, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 141 E Main St, Waterbury, Connecticut |
| Authorized Official Name and Position | Gary Steck (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2037567287 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellmore, Inc. 141 E Main St Waterbury CT 06702-2310 Ph: (203) 574-9000 | Wellmore, Inc. 141 E Main St Waterbury CT 06702-2310 Ph: (203) 756-7287 |
| NPI Number | 1841379013 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 08/23/2016 |
| Medicare PECOS PAC ID | 9931356888 |
|---|---|
| Medicare Enrollment ID | O20120828000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841379013 | NPI | - | NPPES |
| GRP/FACILITY | Other | CT | ANTHEM BCBS OF CT |
| GRP/FACILITY | Other | CT | MHN/MHN TRICARE NORTH |
| GRP/FACILITY | Other | CT | UBH-CONNECTICARE |
| GRP/FACILITY | Other | CT | OPTUM BEHAVIORAL HEALTH |
| 4491935 | Other | CT | CIGNA BEHAVIORAL HEALTH |
| D339123 WATERBURY | Other | CT | BECON HEALTH STRATEGIES |
| GRP/FACILITY | Other | CT | HEALTHYCT |
| GRP/FACILITY | Other | CT | UBH-OXFORD/FREEDOM |
| GRP/FACILITY | Other | CT | UBH/UNITED HEALTHCARE |
| 004039202 | Medicaid | CT | |
| 9211645 | Other | CT | AETNA HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | OPCC-11 (Connecticut) | Primary |
| Provider Name | Christopher M Young |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154359313 PECOS PAC ID: 5597710608 Enrollment ID: I20050322000091 |
| Provider Name | Joan Huskins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487680880 PECOS PAC ID: 9032125869 Enrollment ID: I20060302000346 |
| Provider Name | Susan E Hogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902119589 PECOS PAC ID: 1153510508 Enrollment ID: I20110115000037 |
| Provider Name | Regan M Moriarty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669709135 PECOS PAC ID: 1759533409 Enrollment ID: I20121204000412 |
| Provider Name | Tabassum A Ali |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578819884 PECOS PAC ID: 3274830435 Enrollment ID: I20160401001993 |
| Provider Name | Tamanna Rahman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790067395 PECOS PAC ID: 3274819883 Enrollment ID: I20170414000549 |
| Provider Name | Nicole Borusiewicz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043647373 PECOS PAC ID: 5597028761 Enrollment ID: I20180423000554 |
| Provider Name | Caitlin Mcavoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740686724 PECOS PAC ID: 9032473426 Enrollment ID: I20180511000840 |
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