Basic Information
| Provider Information | |||||||||
| NPI: | 1801102173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OEHMSEN | ||||||||
| FirstName: | CARLEEN | ||||||||
| MiddleName: | NATASHA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 995 DAY HILL RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060951722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607315522 | ||||||||
| FaxNumber: | 8607315536 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 ELM ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607413001 | ||||||||
| FaxNumber: | 8607418332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2010 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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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 | 101YP2500X | 001766 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 004025177 | 05 | CT | MEDICAID |