Basic Information
| Provider Information | |||||||||
| NPI: | 1306111539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIONIZIO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | RAMOS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS,BA,LPC,NCC | ||||||||
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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: | 141 E MAIN ST | ||||||||
| Address2: | 3RD FLOOR HOME BASED SERVICES | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035750466 | ||||||||
| FaxNumber: | 2035751817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2012 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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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 | 101YP2500X | 002348 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 060669107 | 01 | CT | ANTHEM BCBS OF CT BEHAVIORAL HEALTH-WELLMORE, INC GRP/FACILITY | OTHER | 008049659 | 05 | CT | MEDICAID | 4679990 | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 240816 | 01 | CT | NATIONAL CERTIFIED COUNSELOR/NCC EXPIRES 11/30/2019 | OTHER | 060669107 | 01 | CT | UNITED BEHAVIORAL HEALTH-OPTUM/WELLMORE, INC GRP/FACILITY | OTHER | 060669107 | 01 | CT | UBH-UNITED HEALTHCARE WELLMORE, INC GRP/FACILITY | OTHER | D339209 WATERBURY | 01 | CT | BEACON HEALTH STRATEGIES WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | UBH-OXFORD HEALTH/LIBERTY WELLMORE, INC GRP/FACILITY | OTHER | 9959987 | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER | 539518 | 01 | CT | MANAGED HEALTH NETWORK-MHN | OTHER | 060669107 | 01 | CT | HEALTHY CT-AFFORADABLE HEALTHCARE WELLMORE, INC FACILITY/GROUP | OTHER | 13547449 | 01 | CT | CAQH | OTHER | 539517 | 01 | CT | TRICARE NORTH-MHN | OTHER |