Healthcare Provider Details

I. General information

NPI: 1144561051
Provider Name (Legal Business Name): WESTERN CONNECTICUT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 FEDERAL RD 2ND FLOOR
BROOKFIELD CT
06804-1830
US

IV. Provider business mailing address

828 FEDERAL RD 2ND FLOOR
BROOKFIELD CT
06804-1830
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-0500
  • Fax: 203-702-5345
Mailing address:
  • Phone: 203-885-0500
  • Fax: 203-702-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3248
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3248
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3248
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3248
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3248
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3248
License Number StateCT

VIII. Authorized Official

Name: DR. JESSICA BIREN CAVERLY
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 203-885-0500