Provider Demographics
NPI:1912336843
Name:KISHORE, JOSHUA (LCSW,MSW,BS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:KISHORE
Suffix:
Gender:M
Credentials:LCSW,MSW,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:72 WEST ST
Practice Address - Street 2:DANBURY CLINICAL 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:203-797-9858
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT94271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH/OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherMHN TRICARENORTH
CT13810479OtherCAQH
CT060669107OtherOPTUM/UBH WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTD339229 -DANBURYOtherBEACON HEALTH STRATEGIES
CTPENDINGOtherAETNA BEHAVIORAL HEALTH