Provider Demographics
NPI:1548629538
Name:OUELLETTE, ELISABETH A (LMSW,MSW,BSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LMSW,MSW,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:2ND FLOOR/SCHOOL BASED CHILDREN'S SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-574-9000
Practice Address - Fax:203-574-9006
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CT060669107OtherUBH-UNITED HEALTHCARE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH- WELLMORE GRP/FACILITY
CT004039202Medicaid
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT13818113OtherCAQH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH-OXFORD FREEDOM/LIBERTY WELLMORE FACILITY/GRP
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH-UNITED HEALTHCARE GRP/FACILITY