NPIMap

Organization Active NPI

Wellmore, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Waterbury, CT
National Provider Identifier
1841379013
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
OPCC-11 Issued in CT
Legal business name
WELLMORE, INC.
Practice address
141 E Main St
Waterbury, CT 06702-2310
Phone
(203) 756-7287
Fax
(203) 596-0722
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary Steck, LMFT
Title
Executive Director
Phone
(203) 756-7287

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X OPCC-11 CT Primary

Addresses

Primary practice location

141 E Main St
Waterbury, CT 06702-2310

Mailing address

141 E Main St
Waterbury, CT 06702-2310
Phone (203) 574-9000

Other identifiers 11

IdentifierTypeStateIssuer
GRP/FACILITYOtherCTANTHEM BCBS OF CT
GRP/FACILITYOtherCTMHN/MHN TRICARE NORTH
GRP/FACILITYOtherCTUBH-CONNECTICARE
GRP/FACILITYOtherCTOPTUM BEHAVIORAL HEALTH
4491935OtherCTCIGNA BEHAVIORAL HEALTH
D339123 WATERBURYOtherCTBECON HEALTH STRATEGIES
GRP/FACILITYOtherCTHEALTHYCT
GRP/FACILITYOtherCTUBH-OXFORD/FREEDOM
GRP/FACILITYOtherCTUBH/UNITED HEALTHCARE
004039202MedicaidCT
9211645OtherCTAETNA HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120828000409 CT Part B Supplier - Clinic/Group Practice 9931356888 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
Practice locations: Waterbury, CT

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • Wellmore, Inc

    dba Wellmore, Inc.-Therapeutic Shelter

    • Substance Use Disorder Rehabilitation Clinic/Center
    • Waterbury, CT
    • NPI 1336407915

    O20120828000409

    Same enrollment
  • Wellmore, Inc

    dba Wellmore, Inc.-Waterbury OP Behavioral Health Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Waterbury, CT
    • NPI 1962760561

    O20120828000409

    Same enrollment

National Provider Directory

National Provider Directory

Locations

141 E Main St
Waterbury, CT 06702
Phone (203) 575-0466

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1841379013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "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",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022310",
            "telephone_number": "203-756-7287",
            "fax_number": "203-596-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "STECK",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-756-7287",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "OPCC-11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS OF CT",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN/MHN TRICARE NORTH",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH-CONNECTICARE",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM BEHAVIORAL HEALTH",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "4491935",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BECON HEALTH STRATEGIES",
            "identifier": "D339123 WATERBURY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHYCT",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH-OXFORD/FREEDOM",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH/UNITED HEALTHCARE",
            "identifier": "GRP/FACILITY",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004039202",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH",
            "identifier": "9211645",
            "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 Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.