1730377383 NPI number — MONIQUE E WEST MSW,BA,LCSW

Table of content: MONIQUE E WEST MSW,BA,LCSW (NPI 1730377383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730377383 NPI number — MONIQUE E WEST MSW,BA,LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
MONIQUE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW,BA,LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730377383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 PLAINS RD UNIT 1C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06461-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-693-1050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 PLAINS RD UNIT 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06461-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-693-1050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  082084 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 008711 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004040655 . This is a "HP-MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140008711CT02 . This is a "ANTHEM BCBS OF CT -AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 472092928 . This is a "THREE RIVERS AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4990903 . This is a "CIGNA BEHAVIORAL HEALTH -AWAKEN THE POWER THERAPY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH- UHC AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH- OXFORD/FREEDOM AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH-UNITED HEALTHCARE AWAKEN THE POWER THERAPY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 472092928 . This is a "FEI BEHAVIORAL HEALTH AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0060808 . This is a "BEACON HEALTH- VALUE OPTIONS AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 12755484 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 472092928 . This is a "HEALTHY CT- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM BEHAVIORAL HEALTH CONNECTICARE- AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 472092928 . This is a "MULTI-PLAN -AWAKEN THE POWER THERAPY, LLC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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