Provider Demographics
NPI:1043586092
Name:EAGAN, CAROLINE (LCSW,MSW,BSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:EAGAN
Suffix:
Gender:F
Credentials:LCSW,MSW,BSW
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW,BSW
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:WELLMORE INC-CHILDRENS SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-575-0466
Practice Address - Fax:203-575-1827
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008049710Medicaid
CT060669107OtherUBH/OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherOPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CTPENDINGOtherMHN TRICARENORTH WELLMORE
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH-WELLMORE
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTCAQHOther12656269
CTPENDINGOtherMHN MANAGED HEALTH NETWORK- WELLMORE
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CTD339123- 141 E MAINOtherBEACON HEALTH STRATEGIES
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY