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  7. NPI Record 1063845766

MS. DE'ANDREA L.R. DILLARD MSM, LCSW
Complete NPI Record 1063845766
Social Worker - Clinical in Cheshire, CT

NPI Status: Active since August 16, 2013

Contact Information

1113 S MAIN ST STE F
CHESHIRE, CT
ZIP 06410
Phone: (203) 699-6318

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Other Provider Identifier 1
  27. Other Provider Identifier Type Code 1
  28. Other Provider Identifier State 1
  29. Other Provider Identifier 2
  30. Other Provider Identifier Type Code 2
  31. Other Provider Identifier State 2
  32. Other Provider Identifier Issuer 2
  33. Other Provider Identifier 3
  34. Other Provider Identifier Type Code 3
  35. Other Provider Identifier State 3
  36. Other Provider Identifier Issuer 3
  37. Other Provider Identifier 4
  38. Other Provider Identifier Type Code 4
  39. Other Provider Identifier State 4
  40. Other Provider Identifier Issuer 4
  41. Other Provider Identifier 5
  42. Other Provider Identifier Type Code 5
  43. Other Provider Identifier State 5
  44. Other Provider Identifier Issuer 5
  45. Other Provider Identifier 6
  46. Other Provider Identifier Type Code 6
  47. Other Provider Identifier State 6
  48. Other Provider Identifier Issuer 6
  49. Other Provider Identifier 7
  50. Other Provider Identifier Type Code 7
  51. Other Provider Identifier State 7
  52. Other Provider Identifier Issuer 7
  53. Other Provider Identifier 8
  54. Other Provider Identifier Type Code 8
  55. Other Provider Identifier State 8
  56. Other Provider Identifier Issuer 8
  57. Other Provider Identifier 9
  58. Other Provider Identifier Type Code 9
  59. Other Provider Identifier State 9
  60. Other Provider Identifier Issuer 9
  61. Other Provider Identifier 10
  62. Other Provider Identifier Type Code 10
  63. Other Provider Identifier State 10
  64. Other Provider Identifier Issuer 10
  65. Other Provider Identifier 11
  66. Other Provider Identifier Type Code 11
  67. Other Provider Identifier State 11
  68. Other Provider Identifier Issuer 11
  69. Other Provider Identifier 12
  70. Other Provider Identifier Type Code 12
  71. Other Provider Identifier State 12
  72. Other Provider Identifier Issuer 12
  73. Other Provider Identifier 13
  74. Other Provider Identifier Type Code 13
  75. Other Provider Identifier State 13
  76. Other Provider Identifier Issuer 13
  77. Is Sole Proprietor
  78. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1063845766. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1063845766
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: DE'ANDREA
The first name of the provider, if the provider is an individual.
Provider Middle Name: L.R.
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: MS.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: MSM, LCSW
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 1113 S MAIN ST STE F
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CHESHIRE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CT
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 064103436
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2036996318
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 1113 S MAIN ST STE F
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CHESHIRE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CT
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 064103436
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2036996318
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/16/2013
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/3/2021
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 1041C0700X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 10596
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 008060102
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: CT
Other Provider Identifier 2: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: CT
Other Provider Identifier Issuer 2: UBH-CONNECTICARE WELLMORE GRP/FACILITY
Other Provider Identifier 3: NOT ELIGIBLE
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: CT
Other Provider Identifier Issuer 3: MHN-TRICARE NORTH
Other Provider Identifier 4: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: CT
Other Provider Identifier Issuer 4: UBH-OXFORD LIBERTY/FREEDOM PLAN WELLMORE GRP/FACILITY
Other Provider Identifier 5: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: CT
Other Provider Identifier Issuer 5: UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
Other Provider Identifier 6: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: CT
Other Provider Identifier Issuer 6: HEALTHYCT
Other Provider Identifier 7: PENDING
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: CT
Other Provider Identifier Issuer 7: AETNA BEHAVIORAL HEALTH
Other Provider Identifier 8: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: CT
Other Provider Identifier Issuer 8: UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
Other Provider Identifier 9: 12600248
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: CT
Other Provider Identifier Issuer 9: CAQH
Other Provider Identifier 10: D339210 WATERBURY
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: CT
Other Provider Identifier Issuer 10: BEACON HEALTH STRATEGIES
Other Provider Identifier 11: PENDING
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: CT
Other Provider Identifier Issuer 11: CIGNA BEHAVIORAL HEALTH
Other Provider Identifier 12: 060669107
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: CT
Other Provider Identifier Issuer 12: ANTHEM BCBS OF CT -WELLMORE,INC GROUP/FACILITY CONTRACT
Other Provider Identifier 13: NOT ELIGIBLE
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: CT
Other Provider Identifier Issuer 13: MHN-MANAGED HEALTH NETWORK
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 11/3/2021