Basic Information
| Provider Information | |||||||||
| NPI: | 1346575693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELD | ||||||||
| FirstName: | YOSEF | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | MSW,LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 RANDOLPH AVE | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067101648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 RANDOLPH AVE | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067101648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037979778 | ||||||||
| FaxNumber: | 2037979858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2009 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 008705 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 539521 | 01 | CT | TRICARE NORTH-MHN WELLMORE,INC | OTHER | 539521 | 01 | CT | MHN- WELLMORE,INC. | OTHER | 12770882 | 01 | CAQH | OTHER | 5942959 | 01 | CT | AETNA BEHAVIORAL HEALTH-WELLMORE,INC | OTHER | 008054990 | 05 | CT | MEDICAID |