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General NPI Number Information
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NPI Number | 1144561051
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Entity Type | Organization
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Legal Business Name | WESTERN CONNECTICUT BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 828 FEDERAL RD 2ND FLOOR
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City | BROOKFIELD
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State | CT
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Zip | 06804-1830
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Country | US
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Telephone | 203-885-0500
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Fax | 203-702-5345
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Provider Business Mailing Address
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Address Line | 828 FEDERAL RD 2ND FLOOR
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City | BROOKFIELD
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State | CT
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Zip | 06804-1830
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Country | US
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Telephone | 203-885-0500
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Fax | 203-702-5345
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JESSICA BIREN CAVERLY
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Credential | PH.D.
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Telephone | 203-885-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3248
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3248
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 3248
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 3248
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 3248
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3248
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License Number State | CT
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