Healthcare Provider Details

I. General information

NPI: 1851912745
Provider Name (Legal Business Name): BEN'S BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 VALLEYVIEW DR
MIDDLEFIELD CT
06455-1004
US

IV. Provider business mailing address

42 VALLEYVIEW DR
MIDDLEFIELD CT
06455-1004
US

V. Phone/Fax

Practice location:
  • Phone: 860-250-5849
  • Fax: 203-774-1162
Mailing address:
  • Phone: 860-250-5849
  • Fax: 203-774-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JENNA L WAZ
Title or Position: CEO
Credential: MA, BCBA, LBA
Phone: 860-250-5849