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230 Frost Rd Unit B Waterbury CT 06705-2154 | |
| (203) 819-0789 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 230 Frost Rd Unit B, Waterbury, Connecticut |
| Authorized Official Name and Position | Elliot Richelson (PRESIDENT, SECRETARY, AND TREASURER) |
| Authorized Official Contact | 9046054986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
230 Frost Rd Unit B Waterbury CT 06705-2154 Ph: (203) 768-4427 | 230 Frost Rd Unit B Waterbury CT 06705-2154 Ph: (203) 819-0789 |
| NPI Number | 1295130581 |
|---|---|
| Provider Enumeration Date | 10/29/2014 |
| Last Update Date | 04/04/2023 |
| Certification Date | 04/04/2023 |
| Medicare PECOS PAC ID | 1557614856 |
|---|---|
| Medicare Enrollment ID | O20211018000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295130581 | NPI | - | NPPES |
| 008056440 | Medicaid | CT |
| Provider Name | Sarah A Ostrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922245620 PECOS PAC ID: 2860740750 Enrollment ID: I20180809000790 |
| Provider Name | Donna Marie Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760858211 PECOS PAC ID: 2860861705 Enrollment ID: I20221215000685 |
| Provider Name | Samuel Wallace Peloquin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154069045 PECOS PAC ID: 3870957723 Enrollment ID: I20230912001378 |
| Provider Name | Chelsea N Humphrey |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1548555816 PECOS PAC ID: 3678940582 Enrollment ID: I20240118003693 |
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