Provider Demographics
NPI:1841531878
Name:WRIGHT, ELLEN M (MSW,BA,LCSW,LMSW,RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW,BA,LCSW,LMSW,RN
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 1:141 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:203-723-9599
Practice Address - Fax:293-723-9890
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1649104100000X
CTE43376163W00000X
CT94741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTELIGIBLE NOT APPLIEDOtherMHN TRICARENORTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherUBH OXFORD HEALTH/FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTD339209 141 MAIN STOtherBEACON HEALTH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTELIGIBLE NOT APPLIEDOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTELIGIBLE NOT APPLIEDOtherCIGNA BEHAVIORAL HEALTH
CT008062580Medicaid
CT13671856OtherCAQH
CTELIGIBLE NOT APPLIEDMedicare PIN