Healthcare Provider Details

I. General information

NPI: 1720521404
Provider Name (Legal Business Name): FAIRFIELD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BRITTANIA DR
DANBURY CT
06811-2613
US

IV. Provider business mailing address

45 BRITTANIA DR
DANBURY CT
06811-2613
US

V. Phone/Fax

Practice location:
  • Phone: 203-233-1211
  • Fax: 203-900-0699
Mailing address:
  • Phone: 203-233-1211
  • Fax: 203-900-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-05-2201
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-05-2201
License Number StateCT

VIII. Authorized Official

Name: DR. AJIT DOOLABH
Title or Position: OWNER/DIRECTOR
Credential: PH.D., BCBA, LBA
Phone: 203-233-1211