Individual
HEIDI OUTTRIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
197 HAVERFORD ST, HAMDEN, CT 06517
(745) 719-0487
Mailing address
PO BOX 7720, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-0720
(203) 503-3174
(203) 503-3183
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
8837
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306421
—
MA
05
—
1308785
—
MA
01
—
22220002001
BLUE CROSS BLUE SHEILD
MA
01
—
M18684
BLUE CROSS BLUE SHEILD
MA
Enumeration date
10/13/2010
Last updated
08/13/2018
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