Healthcare Provider Details

I. General information

NPI: 1528555877
Provider Name (Legal Business Name): KINDER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2018
Last Update Date: 04/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CRANE ST
FAIRFIELD CT
06825-4316
US

IV. Provider business mailing address

37 CRANE ST
FAIRFIELD CT
06825-4316
US

V. Phone/Fax

Practice location:
  • Phone: 203-521-3956
  • Fax:
Mailing address:
  • Phone: 203-521-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KINDER BROOKE FREEDMAN
Title or Position: CEO
Credential: BCBA
Phone: 203-521-8444