Individual
TABASSUM A ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
141 E MAIN ST, WATERBURY CLINICIAL SERVICES 2ND FLOOR, WATERBURY, CT 06702
(855) 935-5667
(203) 596-0722
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
98808
CT
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
ANCC2012007952
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
005035
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008042033
—
CT
01
—
060669107
UBH-UNITED BEHAVIORAL HEALTH NETWORK WELLMORE GRP/FACILITY
CT
01
—
12671467
CAQH
—
01
—
4853955
CIGNA BEHAVIORAL HEALTH
CT
01
—
507335
MHN/MANAGED HEALTH NETWORK
CT
01
—
9777891
AETNA BEHAVIORAL HEALTH
CT
01
—
CSP.0053391
CONTROLLED SUBSTANCE LICENSE
CT
01
—
D339209 WATERBURY
VALUE OPTIONS/BEACON HEALTH STRATEGIES
CT
Enumeration date
07/24/2012
Last updated
03/07/2023
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