Provider Demographics
NPI:1053787465
Name:WHITE, DARLENE V (LMSW,MSW,BA)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:V
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW,MSW,BA
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 1:72 WEST ST
Practice Address - Street 2:DANBURY CLINICIAL SERVICES
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6531
Practice Address - Country:US
Practice Address - Phone:203-797-9778
Practice Address - Fax:203-797-9358
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002448104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUBH- CONNECTICARE WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA HEALTH PLAN
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CTPENDINGOtherCAQH
CTPENDINGMedicaid
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE/GRP/FACILITY
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUBH/OXFORD HEALTH-LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTPENDINGMedicaid