Provider Demographics
NPI:1225374945
Name:BRINCKERHOFF, VICTORIA E (MSW,BA,LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:BRINCKERHOFF
Suffix:
Gender:F
Credentials:MSW,BA,LCSW
Other - Prefix:
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Other - Middle Name:
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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 2:3RD FLOOR HOME BASED 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:203-575-1817
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT90651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUBH-OXFORD HEALTH/LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CTD339209-141 E MAINOtherVALUE OPTIONS
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CTPENDINGOtherMHN-TRICARE NORTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICUT WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT008060530Medicaid
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT13646056OtherCAQH
CTPENDINGOtherMHN-TRICARE NORTH