Basic Information
| Provider Information | |||||||||
| NPI: | 1235244690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLBERT | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 664 PROSPECT AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061054203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602334830 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Practice Location | |||||||||
| Address1: | 664 PROSPECT AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061054203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602334830 | ||||||||
| FaxNumber: | 8602316222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 002149 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 140002149CT01 | 01 | CT | ANTHEM BC & BS | OTHER | 199553 | 01 | MHN | OTHER | 133543 | 01 | CT | VALUE OPTIONS | OTHER | HAS787 | 01 | CT | OXFORD HEALTH PLANS | OTHER |