Individual
ELISABETH A OUELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW,MSW,BSW
Contact information
Practice address
141 E MAIN ST, 2ND FLOOR/SCHOOL BASED CHILDREN'S SERVICES, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
002752
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004039202
—
CT
01
—
060669107
UBH-UNITED HEALTHCARE GRP/FACILITY
CT
01
—
13818113
CAQH
CT
01
—
NOT ELIGIBLE
MHN TRICARENORTH
CT
01
—
PENDING
CIGNA BEHAVIORAL HEALTH
CT
Enumeration date
02/18/2016
Last updated
04/27/2016
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