Basic Information
| Provider Information | |||||||||
| NPI: | 1851662829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASWELL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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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: | 402 E MAIN ST | ||||||||
| Address2: | WATERBURY ADULT SERVICES | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037551143 | ||||||||
| FaxNumber: | 2037533274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2012 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 3047 | CT | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 060669107 | 01 | CT | ANTHEM BCBC OF CT FACILITY/GRP WELLMORE | OTHER | 060669107 | 01 | CT | UBH-OXFORD LIBERTY/FREEDOM GRP/FACILITY-WELLMORE | OTHER | 13817567 | 01 | CT | CAQH | OTHER | D339123-141 E MAIN | 01 | CT | VALUE OPTIONS | OTHER | PENDING | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 060669107 | 01 | CT | UBH-CONNECTICARE GRP/FACILITY WELLMORE | OTHER | PENDING | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER | 008064297 | 05 | CT | MEDICAID | 060669107 | 01 | CT | HEALTHYCT GRP/FACILITY-WELLMORE | OTHER | 060669106 | 01 | CT | UNITED BEHAVIORAL HEALTH GRP/FACILITY-WELLMORE | OTHER | NOT ELIGIBLE | 01 | CT | MHN MANAGE HEALTH NETWORK | OTHER | NOT ELIGIBLE | 01 | CT | MHN TRICARENORTH | OTHER | 060669107 | 01 | CT | UBH-UNITED HEALTHCARE GRP/FACILITY WELLMORE | OTHER |