Healthcare Provider Details

I. General information

NPI: 1487155560
Provider Name (Legal Business Name): INTEGRATED ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MOUNTAIN VIEW AVE
AVON CT
06001-3812
US

IV. Provider business mailing address

54 MOUNTAIN VIEW AVE
AVON CT
06001-3812
US

V. Phone/Fax

Practice location:
  • Phone: 860-716-4192
  • Fax:
Mailing address:
  • Phone: 860-716-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. INGO BERGSTEINSSON
Title or Position: OWNER
Credential:
Phone: 860-716-4192