Provider Demographics
NPI:1073871851
Name:LOTT, TASHA E (MSW,BA,LMSW)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:E
Last Name:LOTT
Suffix:
Gender:F
Credentials:MSW,BA,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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 1:70 PINE ST
Practice Address - Street 2:WATERBURY CLINICAL SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2169
Practice Address - Country:US
Practice Address - Phone:203-935-5667
Practice Address - Fax:203-596-0722
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT1115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CTD339225 PINE STREETOtherVALUE OPTIONS
CTNOT ELIGIBLEOtherMHN TRICARE NORTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherHEALTHTYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH FREEDOM/LIBERTY OXFORD HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTH CARE WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEMedicare PIN
CTPENDINGOtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY