Provider Demographics
NPI:1477616100
Name:BAYRON, NELSON (MSW)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:BAYRON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1555
Mailing Address - Country:US
Mailing Address - Phone:860-621-8093
Mailing Address - Fax:860-628-9801
Practice Address - Street 1:790 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1555
Practice Address - Country:US
Practice Address - Phone:860-621-8093
Practice Address - Fax:860-628-9801
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC009024OtherTRICARE
CT140000416CT01OtherANTHEM BEHAVIORAL HEALTH
CT0004212003OtherAETNA