Provider Demographics
NPI:1497197701
Name:HILL, JENELLE (MSW,BASW,LMSW)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:MSW,BASW,LMSW
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 1:141 E MAIN ST
Practice Address - Street 2:WATEBURY CLINICAL SERVICES 2ND FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-597-4070
Practice Address - Fax:203-597-4048
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1398104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH OXFORD HEALTH FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT008060546Medicaid
CT060669017OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT13559879OtherCAQH
CTD339209 WATERBURYOtherBEACON HEALTH STRATEGIES
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK