Healthcare Provider Details

I. General information

NPI: 1245786003
Provider Name (Legal Business Name): QUANTUM BEHAVIORAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 LEAD MINE BROOK RD
HARWINTON CT
06791-1315
US

IV. Provider business mailing address

163 LEADMINE BROOK ROAD
HARWINTON CT
06791
US

V. Phone/Fax

Practice location:
  • Phone: 860-338-3130
  • Fax:
Mailing address:
  • Phone: 860-338-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT ALLYN RODERICK
Title or Position: DIRECTOR/SENIOR BEHAVIOR ANLAYST
Credential: BCBA
Phone: 860-338-3130