Basic Information
| Provider Information | |||||||||
| NPI: | 1477828697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDES | ||||||||
| FirstName: | SAVANA | ||||||||
| MiddleName: | LOURDES | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MSW,BA,LMSW | ||||||||
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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: | 72 WEST ST | ||||||||
| Address2: | DANBURY CLINICAL SERVICES | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037979778 | ||||||||
| FaxNumber: | 2037979858 | ||||||||
| 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 | 104100000X | 1584 | CT | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | D339227-DANBURY | 01 | CT | VALUE OPTIONS | OTHER | 060669107 | 01 | CT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY | OTHER | 136468979 | 01 | CT | CAQH | OTHER | 008060589 | 05 | CT | MEDICAID | PENDING | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 060669107 | 01 | CT | HEALTHYCT WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | UBH- CONNECTICARE WELLMORE GRP/FACILITY | OTHER | NOT ELIGIBLE | 01 | CT | MHN TRICARE NORTH | OTHER | NOT ELIGIBLE | 01 | CT | MHN MANAGE HEALTH NETWORK | OTHER | 060669107 | 01 | CT | UBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | UNITED BEHAVIORAL HEALTH | OTHER | PENDING | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER |