| Southeastern Mental Health Authority | |
|
401 West Thames Street Building 301 Norwich CT 06360 | |
| (860) 859-4674 | |
| (860) 859-4790 |
| Full Name | Southeastern Mental Health Authority |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 West Thames Street, Norwich, Connecticut |
| Authorized Official Name and Position | Stephen A Dipietro (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8604186923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Mental Health Authority 401 West Thames Street Building 301 Norwich CT 06360 Ph: (860) 859-4674 | Southeastern Mental Health Authority 401 West Thames Street Building 301 Norwich CT 06360 Ph: (860) 859-4674 |
| NPI Number | 1902831548 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 03/16/2016 |
| Medicare PECOS PAC ID | 8022915677 |
|---|---|
| Medicare Enrollment ID | O20040319000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902831548 | NPI | - | NPPES |
| 004220307 | Medicaid | CT | |
| 004120200 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Denise E Boras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336200328 PECOS PAC ID: 5395646343 Enrollment ID: I20040114000318 |
| Provider Name | Cynthia Lheureux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033178926 PECOS PAC ID: 6204823693 Enrollment ID: I20040428000238 |
| Provider Name | Robert A Zepf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437201159 PECOS PAC ID: 5092797084 Enrollment ID: I20040603000556 |
| Provider Name | Kathleen C Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982616587 PECOS PAC ID: 5698758415 Enrollment ID: I20040611000242 |
| Provider Name | Janet Roselle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245383439 PECOS PAC ID: 8426032996 Enrollment ID: I20040614001471 |
| Provider Name | Elizabeth Anne Dominguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184784886 PECOS PAC ID: 2769445824 Enrollment ID: I20041109001024 |
| Provider Name | Melissa Deangelis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770659294 PECOS PAC ID: 8022060268 Enrollment ID: I20050215001060 |
| Provider Name | Chris Burke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861568388 PECOS PAC ID: 6800843210 Enrollment ID: I20050406001198 |
| Provider Name | Jonathan A Luysterborghs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821055716 PECOS PAC ID: 0941215016 Enrollment ID: I20060210000039 |
| Provider Name | Barclay G Caras |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346265592 PECOS PAC ID: 7012913510 Enrollment ID: I20061005000491 |
| Provider Name | Mary E Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780628636 PECOS PAC ID: 5496757320 Enrollment ID: I20070206000588 |
| Provider Name | Albert C Singletary |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073617171 PECOS PAC ID: 1254432560 Enrollment ID: I20070730000768 |
| Provider Name | Mary Jane King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679638993 PECOS PAC ID: 1355432519 Enrollment ID: I20070802000528 |
| Provider Name | Ernest Nozil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679634729 PECOS PAC ID: 8426149691 Enrollment ID: I20070802000545 |
| Provider Name | Laura J Parsons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275685992 PECOS PAC ID: 6305938226 Enrollment ID: I20070823000545 |
| Provider Name | Gina Higgins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114110160 PECOS PAC ID: 3577656503 Enrollment ID: I20070907000404 |
| Provider Name | Courtney M Malcolm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093909525 PECOS PAC ID: 8527138817 Enrollment ID: I20080529000187 |
| Provider Name | John R. Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942476817 PECOS PAC ID: 1456423946 Enrollment ID: I20080627000177 |
| Provider Name | Patricia A Medling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851562219 PECOS PAC ID: 9436224722 Enrollment ID: I20080821000176 |
| Provider Name | Cynthia A Winer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215181870 PECOS PAC ID: 8628133600 Enrollment ID: I20090209000486 |
| Provider Name | Rhonda J Labua |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215166004 PECOS PAC ID: 5496800658 Enrollment ID: I20090911000417 |
| Provider Name | Pamela J Dole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245444702 PECOS PAC ID: 3577655471 Enrollment ID: I20100712000732 |
| Provider Name | Joseph Patrick Lang |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164599031 PECOS PAC ID: 1052500857 Enrollment ID: I20110110000683 |
| Provider Name | Lori D Orend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619031309 PECOS PAC ID: 7113116575 Enrollment ID: I20110115000087 |
| Provider Name | Stephanie A Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407154149 PECOS PAC ID: 7618152869 Enrollment ID: I20110503000457 |
| Provider Name | Cynthia L Mason Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356668040 PECOS PAC ID: 7810156775 Enrollment ID: I20120313000031 |
| Provider Name | Roxana Rosario |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104120443 PECOS PAC ID: 1951566173 Enrollment ID: I20120712000767 |
| Provider Name | Colleen E Phillips White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063766400 PECOS PAC ID: 6901042639 Enrollment ID: I20130424000757 |
| Provider Name | Emmanuelle R Howe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205087053 PECOS PAC ID: 4284874496 Enrollment ID: I20130711000848 |
| Provider Name | Fanny E Aguilar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760733786 PECOS PAC ID: 6901047414 Enrollment ID: I20130725000845 |
| Provider Name | Gina M Velez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497176614 PECOS PAC ID: 0648409888 Enrollment ID: I20140210000988 |
| Provider Name | Tara A Beatty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699192013 PECOS PAC ID: 8022235456 Enrollment ID: I20140808000838 |
| Provider Name | Harvey W Gemme |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295149649 PECOS PAC ID: 4486871563 Enrollment ID: I20140813001976 |
| Provider Name | Robin B Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962746537 PECOS PAC ID: 2961621750 Enrollment ID: I20140909001910 |
| Provider Name | Mark E Mcguinness |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346342490 PECOS PAC ID: 4688893431 Enrollment ID: I20140910000947 |
| Provider Name | Anabell Ramos-merced |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215134085 PECOS PAC ID: 8022336965 Enrollment ID: I20150406000975 |
| Provider Name | Eric Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235534843 PECOS PAC ID: 8729307459 Enrollment ID: I20150501000291 |
| Provider Name | Paul E. Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083051684 PECOS PAC ID: 4486975018 Enrollment ID: I20150608000826 |
| Provider Name | Marie Louise Malboeuf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770844904 PECOS PAC ID: 5799080800 Enrollment ID: I20160229000556 |
| Provider Name | Chika J Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447599196 PECOS PAC ID: 8123318367 Enrollment ID: I20160601000331 |
| Provider Name | Lori Dvorak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679634711 PECOS PAC ID: 6406146414 Enrollment ID: I20160603000663 |
| Provider Name | Alaina N Velasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386716561 PECOS PAC ID: 2264726074 Enrollment ID: I20160802001220 |
| Provider Name | Olufumilayo Agbaje |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447621230 PECOS PAC ID: 0749576163 Enrollment ID: I20160912001927 |
| Provider Name | Siobhan Ashley Gaston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295254340 PECOS PAC ID: 6800156167 Enrollment ID: I20180205002476 |
| Provider Name | Alma Rosa Barreto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114462751 PECOS PAC ID: 4789949801 Enrollment ID: I20180521000647 |
| Provider Name | Kathleen Susan Hull |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558840603 PECOS PAC ID: 7911258330 Enrollment ID: I20180925001668 |
| Provider Name | Lisa Cygan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134689714 PECOS PAC ID: 8729329719 Enrollment ID: I20190329002250 |
| Provider Name | Chanel Justice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609335397 PECOS PAC ID: 3678815982 Enrollment ID: I20190506002211 |
| Provider Name | Kaitlyn Occhionero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447813886 PECOS PAC ID: 1557604329 Enrollment ID: I20190517001014 |
| Provider Name | Joan Telemaque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619447935 PECOS PAC ID: 9234462649 Enrollment ID: I20190617002020 |
| Provider Name | Brian C Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598130437 PECOS PAC ID: 1658600499 Enrollment ID: I20190904002079 |
| Provider Name | Carleigh Glynn Hannah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851934947 PECOS PAC ID: 9739511817 Enrollment ID: I20191111001839 |
| Provider Name | Mary Kenny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760032023 PECOS PAC ID: 0648604033 Enrollment ID: I20191217002832 |
| Provider Name | Michelle Rossignol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780193185 PECOS PAC ID: 3870928641 Enrollment ID: I20200124001657 |
| Provider Name | Cheyenne L Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275167959 PECOS PAC ID: 1557785367 Enrollment ID: I20200724002836 |
| Provider Name | Katherine Sara Reiners |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053710996 PECOS PAC ID: 1153749072 Enrollment ID: I20200909002264 |
| Provider Name | Shelley Beth Kingsbury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104462654 PECOS PAC ID: 3779993415 Enrollment ID: I20201108000000 |
| Provider Name | Ayanna K Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467911743 PECOS PAC ID: 4880008010 Enrollment ID: I20210130000025 |
| Provider Name | Erin Mendonca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942885405 PECOS PAC ID: 7810304672 Enrollment ID: I20210324001162 |
| Provider Name | Kaila Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346816105 PECOS PAC ID: 9032519830 Enrollment ID: I20210616001257 |
| Provider Name | Steven Ambrico |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548634876 PECOS PAC ID: 4183029556 Enrollment ID: I20210823002857 |
| Provider Name | Erin Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780991117 PECOS PAC ID: 2466876636 Enrollment ID: I20211222002162 |
| Provider Name | Amy A Piersa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750892139 PECOS PAC ID: 6305237249 Enrollment ID: I20220103001082 |
| Provider Name | Bonita Byars |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639830581 PECOS PAC ID: 0749673069 Enrollment ID: I20220209002577 |
| Provider Name | Kelly Patricia Vanasse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912665050 PECOS PAC ID: 2163815150 Enrollment ID: I20220216000829 |
| Provider Name | Shannon Klock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992449649 PECOS PAC ID: 7315314671 Enrollment ID: I20221031001315 |
| Provider Name | Christina Mckenzie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386359826 PECOS PAC ID: 4587036249 Enrollment ID: I20230207002346 |
| Provider Name | Heather Lynn Fournier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245896281 PECOS PAC ID: 5193180834 Enrollment ID: I20230502000924 |
| Provider Name | Kristen Fernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881301711 PECOS PAC ID: 1153787239 Enrollment ID: I20230516000144 |
| Provider Name | Timothy Jean Schlehofer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679286413 PECOS PAC ID: 5799143467 Enrollment ID: I20230628001707 |
| Provider Name | Ellen Catherine Crichton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427607712 PECOS PAC ID: 1557710720 Enrollment ID: I20231213001534 |
| Provider Name | Nicole Gagnon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578932158 PECOS PAC ID: 8729438189 Enrollment ID: I20231227001334 |
| Provider Name | Mercury Ripley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770897043 PECOS PAC ID: 4789831413 Enrollment ID: I20240108000205 |
| Provider Name | Yabneel Marrero-canales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275004012 PECOS PAC ID: 6608216742 Enrollment ID: I20240506004284 |
Jeigh Hayes Health And Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 New London Tpke, Office 3, Suite A, Norwich, CT 06360 Phone: 860-857-8176 | |
Cedarwood Counseling, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 12 Case St Ste 202, Norwich, CT 06360 Phone: 860-303-3051 | |
Catholic Charities Diocese Of Norwich Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 331 Main St, Norwich, CT 06360 Phone: 860-889-8346 | |
Vwb Counseling, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 12 Case Street, Suite 302, Norwich, CT 06360 Phone: 860-984-3786 | |
Julie A Longton Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 20 Carver Ave, Norwich, CT 06360 Phone: 860-886-8233 | |
Therapeutic Matters Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 80 Sherman St, Suite F, Norwich, CT 06360 Phone: 860-383-2171 Fax: 860-222-3218 | |
Carol Campbell Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 18 Oneco St, Suite 3, Norwich, CT 06360 Phone: 860-984-3190 |