WELLMORE, INC (NPI# 1336407915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336407915 |
| Entity Type | Organization |
| Organization Name | WELLMORE, INC |
| Other Organization Name | WELLMORE, INC.-THERAPEUTIC SHELTER |
| Practice Address |
142 Griggs St Waterbury CT 06704-3110 |
| Mailing Address |
141 E Main St Waterbury CT 06702-1701 |
| Practice Telephone | 2035741419 |
| Practice Fax Number | 2035784180 |
| Mailing Telephone | 2035749000 |
| Mailing Fax Number | 2035749006 |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2014-06-11 |
| Authorized Official Name | GARY STECK (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2035749000 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004039202 | 05 |
| Other Name | Type Code |
|---|---|
| Wellmore, Inc.-Therapeutic Shelter | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962760561 | Wellmore, Inc | Clinic/Center | 402 East Main St, Waterbury Outpatient Behavioral Health Services, Waterbury, CT 06702-1701 | 2012-05-02 |
| Street Address |
142 GRIGGS ST |
| City | WATERBURY |
| State | CT |
| Zip Code | 06704-3110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609098193 | Michael E Garrard | Counselor | 142 Griggs St, Waterbury, CT 06704-3110 | 2007-05-03 |
| 1629678552 | Kenny Perez | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2020-10-29 |
| 1821602772 | Paul Robinson | Social Worker | 142 Griggs St, Waterbury, CT 06704-3110 | 2020-09-08 |
| 1215549506 | Desiree Herens | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2020-08-19 |
| 1558918862 | Mackenzie Smith | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2019-08-21 |
| 1144876152 | Dawn Engelhard | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2019-08-15 |
| 1144727793 | Jacqueline Dicandia | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2018-04-10 |
| 1316461015 | Amanda Lebron | Student in an Organized Health Care Education/Training Program | 142 Griggs St, Waterbury, CT 06704-3110 | 2017-08-03 |
| 1093117772 | Monique Dagraca | Community Health Worker | 142 Griggs St, Therapeutic Shelter, Waterbury, CT 06704-3110 | 2014-09-24 |
| 1376960724 | Michael G Soneson | Social Worker | 142 Griggs St, Waterbury, CT 06704-3110 | 2014-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104436757 | John Franco Deleo | Physical Therapist | 8 S Commons Road, Waterbury, CT 06704 | 2020-08-07 |
| 1679108492 | Sky Health Group PC | Family Medicine | 64 Blue Ridge Drive, Waterbury, CT 06704 | 2020-03-12 |
| 1801446554 | George Ahyia Osae Jr. | Physician Assistant | 67 Buckland Dr, Waterbury, CT 06704 | 2019-09-16 |
| 1730629551 | Camille Lois Thomas | Licensed Practical Nurse | 64 Santoro St, Waterbury, CT 06704 | 2017-02-27 |
| 1083925689 | Allan Majeski | Speech-Language Pathologist | 100 Blueridge Drive Extension, Waterbury, CT 06704 | 2010-06-29 |
| 1417273384 | Michael Augustine | Marriage & Family Therapist | 678 Chase Parkway, Waterbury, CT 06704 | 2010-04-16 |
| 1750606000 | Cheryl Lynn Wilson | Social Worker | 103 Kara Drive, Waterbury, CT 06704 | 2010-03-30 |
| 1821212101 | Cesar Augusto Pascal | Dentist | Waterbury Dental Care P.C., 558 Chase Avenue, Waterbury, CT 06704 | 2007-04-11 |
| 1639204688 | Occupational Health Centers of The Southwest, P.a., P.C. | Clinic/Center | 8 South Commons Road, Waterbury, CT 06704 | 2007-02-22 |
| 1053850578 | Erica Jo Cracco | Pharmacist | 240 Chase Ave, Waterbury, CT 06704 | 2017-02-16 |
| Find all providers in zip 06704 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.