Provider Demographics
NPI:1194070086
Name:CORNING, JEFFREY R (MSW,BA,LMSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:CORNING
Suffix:
Gender:M
Credentials:MSW,BA,LMSW
Other - Prefix:
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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 1:141 E MAIN ST
Practice Address - Street 2:WATERBURY CLINICAL SERVICES 2ND FLOOR
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
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT1934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherANTHEM BCBS OF CT BEHAVIORAL HEALTH-WELLMORE GRP/FACILITY
CT060669107OtherUBH/UNITED HEALTH CARE WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH
CT060669107OtherUBH/OXFORD FREEDOM/OXFORD LIBERTY WELLMORE GRP/FACILITY060669107
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTD339209 WATERBURYOtherBEACON HEALTH STRATEGIES WELLMORE GRP/FACILITY
CT008060097Medicaid
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CT13605884OtherCAQH
CTNOT ELIGIBLEOtherMHN TRICARE NORTH
CT008060097Medicaid