Active NPI
Elisabeth A Ouellette, LMSW,MSW,BSW
- Social Worker
- Waterbury, CT
National Provider Identifier
1548629538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 002752
- Practice address
- 141 E Main St
2ND Floor/School Based Children's Services
Waterbury, CT 06702-2310 - Phone
- (203) 574-9000
- Fax
- (203) 574-9006
- NPI assigned
- Feb 18, 2016
- Last updated
- Apr 27, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 002752 | CT | Primary |
Addresses
Primary practice location
141 E Main St
2ND Floor/School Based Children's Services
Waterbury, CT 06702-2310
Mailing address
141 E Main St
4TH Floor Administration
Waterbury, CT 06702-2310
Phone (203) 574-9000
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060669107 | Other | CT | UBH-OXFORD FREEDOM/LIBERTY WELLMORE FACILITY/GRP |
| PENDING | Other | CT | AETNA BEHAVIORAL HEALTH |
| 004039202 | Medicaid | CT | |
| 060669107 | Other | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| NOT ELIGIBLE | Other | CT | MHN TRICARENORTH |
| 060669107 | Other | CT | UNITED BEHAVIORAL HEALTH- WELLMORE GRP/FACILITY |
| PENDING | Other | CT | CIGNA BEHAVIORAL HEALTH |
| 060669107 | Other | CT | HEALTHYCT WELLMORE GRP/FACILITY |
| 13818113 | Other | CT | CAQH |
| 060669107 | Other | CT | UBH-UNITED HEALTHCARE GRP/FACILITY |
| NOT ELIGIBLE | Other | CT | MHN MANAGED HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002752 | CT | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellmore, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Wellmore, Inc.-Therapeutic Shelter
- Substance Use Disorder Rehabilitation Clinic/Center
- Waterbury, CT
- NPI 1336407915
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461715200000",
"number": "1548629538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 E MAIN ST",
"address_2": "4TH FLOOR ADMINISTRATION",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067022310",
"telephone_number": "203-574-9000",
"fax_number": "203-574-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 E MAIN ST",
"address_2": "2ND FLOOR/SCHOOL BASED CHILDREN'S SERVICES",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067022310",
"telephone_number": "203-574-9000",
"fax_number": "203-574-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OUELLETTE",
"first_name": "ELISABETH",
"middle_name": "A",
"credential": "LMSW,MSW,BSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-18",
"last_updated": "2016-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CT",
"license": "002752",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH-OXFORD FREEDOM/LIBERTY WELLMORE FACILITY/GRP",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA BEHAVIORAL HEALTH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004039202",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OF CT WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH-CONNECTICARE WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN TRICARENORTH",
"identifier": "NOT ELIGIBLE",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH- WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHYCT WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13818113",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH-UNITED HEALTHCARE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN MANAGED HEALTH NETWORK",
"identifier": "NOT ELIGIBLE",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.