Provider Demographics
NPI:1225263130
Name:KELLEY, CATERINA (LADC,LMSW, MSW,BA)
Entity Type:Individual
Prefix:MRS
First Name:CATERINA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LADC,LMSW, MSW,BA
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 1:30 PECK RD STE 2203
Practice Address - Street 2:TORRINGTON CLINICAL SERVICES
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-626-7007
Practice Address - Fax:860-626-7014
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000864101YA0400X
CT1419104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008037438Medicaid
CT12715953OtherCAQH
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT060669107OtherUBH-OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CTNOT ELIGIBLEMedicare PIN
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT12715953OtherCAQH
CT549789OtherMHN MANAGED HEALTH NETWORK
CT008037438Medicaid
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT9931723OtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CTPENDING IN REVIEWOtherCIGNA BEHAVIORAL HEALTH