Healthcare Provider Details

I. General information

NPI: 1811387012
Provider Name (Legal Business Name): BEHAVIOR SERVICES OF NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FABYAN RD
NORTH GROSVENORDALE CT
06255-1506
US

IV. Provider business mailing address

185 FABYAN RD
NORTH GROSVENORDALE CT
06255-1506
US

V. Phone/Fax

Practice location:
  • Phone: 860-315-0565
  • Fax: 860-315-0565
Mailing address:
  • Phone: 860-315-0565
  • Fax: 860-315-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number002562
License Number StateCT

VIII. Authorized Official

Name: DR. MICHAEL WEINBERG
Title or Position: MANAGER
Credential: PH.D., LP, BCBA-D
Phone: 860-315-0565