Basic Information
| Provider Information | |||||||||
| NPI: | 1265549190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNNICUTT | ||||||||
| FirstName: | CHRISTIE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | PHD,LCSW,MSW,BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 E MAIN ST | ||||||||
| Address2: | 4TH FLOOR ADMINISTRATION | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 E MAIN ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037551143 | ||||||||
| FaxNumber: | 2037551447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 006181 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2655693 | 01 | CT | CIGNA BEHAVIORAL HEALTH WELLMORE | OTHER | 060669107 | 01 | CT | UBH/ UNITED HEALTHCARE WELLMORE GRP/FACILITY | OTHER | 11652959 | 01 | CT | CAQH | OTHER | 470744 PENDING | 01 | CT | MHN TRICARENORTH WELLMORE | OTHER | 004263951 | 05 | CT | MEDICAID | 060669107 | 01 | CT | UBH/CONNECTICARE WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | OPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY | OTHER | 10450310-402 E MAIN | 01 | CT | BEACON HEALTH STRATEGIES, INC. | OTHER | 470744 | 01 | CT | MHN MANAGED HEALTH NETWORK WELLMORE | OTHER | 060669107 | 01 | CT | UBH/OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | HEALHTYCT WELLMORE GRP/FACILITY | OTHER | 9235368 | 01 | CT | AETNA BEHAVIORAL HEALTH WELLMORE | OTHER |