Provider Demographics
NPI:1114313947
Name:PERALTA, ELISABETH D (LCSW,MSW,BSW,ASW)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:D
Last Name:PERALTA
Suffix:
Gender:F
Credentials:LCSW,MSW,BSW,ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1701
Practice Address - Country:US
Practice Address - Phone:203-574-9000
Practice Address - Fax:203-574-9006
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60221041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0808064941Medicaid
CT13818187OtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH/OFORD FREEDOM-LIBERTY GRP/FACILITY
CT060669107OtherUBH/CONNECTICTUT GRP/FACILITY
CTD339210 402 E MAINOtherBEACON HEALTH STRATEGIES
CTPENDINGOtherMHN TRICARE NORTH
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherHEALTHYCT GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherANTHEM BCBS OF CT GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE GRP/FACILITY