Basic Information
Provider Information
NPI: 1851594873
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARON
FirstName: AIMEE
MiddleName: HAYWARD
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HAYWARD
OtherFirstName: AIMEE
OtherMiddleName: NICOLE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 200 RETREAT AVE
Address2: HARTFORD HOSPITAL PSYCHIATRY DEPT
City: HARTFORD
State: CT
PostalCode: 061063309
CountryCode: US
TelephoneNumber: 8605457200
FaxNumber:  
Practice Location
Address1: 200 RETREAT AVE
Address2: HARTFORD HOSPITAL PSYCHIATRY DEPT
City: HARTFORD
State: CT
PostalCode: 061063309
CountryCode: US
TelephoneNumber: 8605457200
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2007
LastUpdateDate: 05/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  N Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
1041C0700X007269CTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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