Basic Information
| Provider Information | |||||||||
| NPI: | 1487680880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSKINS | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LCSW,LADC,MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 E MAIN ST | ||||||||
| Address2: | 4TH FLOOR ADMIISTRATION | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 E MAIN ST | ||||||||
| Address2: | WATERBURY OP ADULT SERVICES | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037551143 | ||||||||
| FaxNumber: | 2037533274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| 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 | 1041C0700X | 5994 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 891 | CT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 060669107 | 01 | CT | OPTUM BEHAVIORAL HEALTH/UBH GRP/FACILITY WELLMORE | OTHER | 060669107 | 01 | CT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY | OTHER | 10450310-402 E MAIN | 01 | CT | BEACON HEALTH STRATEGIES, INC. | OTHER | 2266879 | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 004039202 | 05 | CT | MEDICAID | CAC-4700 | 01 | CT | CAC-CERTIFIED ADDICTION COUNSELOR | OTHER | 060669107 | 01 | CT | UBH/CONNECTICARE WELLMORE GRP/FACILITY | OTHER | 7473885 | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER | ICADC-4700 | 01 | CT | ICADC-INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR | OTHER | 11518584 | 01 | CAQH | OTHER | 06066917 | 01 | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY | OTHER | 374134 | 01 | CT | MHN TRICARE NORTH | OTHER | 060669107 | 01 | CT | UBH-OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY | OTHER | 374134 | 01 | CT | MHN MANAGED HEALTH NETWORK | OTHER | 060669107 | 01 | CT | HEALTHYCT WELLMORE GRP/FACILITY | OTHER | CCDP-D-4700 | 01 | CT | CCDP-D CERTIFIED CO-OCCURING DISORDERS PROFESSIONAL-DIPLOMATE | OTHER | ICCDP-D-4700 | 01 | CT | ICCDP-INTERNATIONALLY CERTIFIED CO-OCCURRING DISORDERS PROFESSIONAL | OTHER |