Provider Demographics
NPI:1669709135
Name:MORIARTY, REGAN M (MSW,BA,LCSW)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:M
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MSW,BA,LCSW
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 1:402 E MAIN ST
Practice Address - Street 2:WATERBURY OP ADULT SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1701
Practice Address - Country:US
Practice Address - Phone:203-755-1143
Practice Address - Fax:203-753-3274
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT80841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CTD339210 WATERBURY OPOtherVALUE OPTIONS
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT511290OtherMHN MANAGED HEALTH NETWORK
CT9640636OtherAETNA BEHAVIORAL HEALTH
CT4080505OtherCIGNA BEHAVIORAL HEALTH WELLMORE INDIVIDUAL
CT008049706Medicaid
CT060669107OtherUBH-LIBERTY/FREEDOM OXFORD HEALTH WELLMORE GRP/FACILITY
CT12483984OtherCAQH
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT511290OtherMHN TRICARE NORTH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTD400080886Medicare PIN