Provider Demographics
NPI:1841379013
Name:WELLMORE, INC.
Entity Type:Organization
Organization Name:WELLMORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-756-7287
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:
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:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-756-7287
Practice Address - Fax:203-596-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTOPCC-11261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTGRP/FACILITYOtherANTHEM BCBS OF CT
CTGRP/FACILITYOtherMHN/MHN TRICARE NORTH
CTGRP/FACILITYOtherUBH-CONNECTICARE
CTGRP/FACILITYOtherOPTUM BEHAVIORAL HEALTH
CT4491935OtherCIGNA BEHAVIORAL HEALTH
CTD339123 WATERBURYOtherBECON HEALTH STRATEGIES
CTGRP/FACILITYOtherHEALTHYCT
CTGRP/FACILITYOtherUBH-OXFORD/FREEDOM
CTGRP/FACILITYOtherUBH/UNITED HEALTHCARE
CT004039202Medicaid
CT9211645OtherAETNA HEALTH
CTGRP/FACILITYOtherHEALTHYCT