Healthcare Provider Details

I. General information

NPI: 1659814366
Provider Name (Legal Business Name): A BEHAVIORAL APPROACH, LAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DAVIS RD WEST
OLD LYME CT
06371
US

IV. Provider business mailing address

4 DAVIS RD WEST
OLD LYME CT
06371
US

V. Phone/Fax

Practice location:
  • Phone: 860-531-9621
  • Fax: 860-391-8668
Mailing address:
  • Phone: 860-531-9621
  • Fax: 860-391-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11210373
License Number StateCT

VIII. Authorized Official

Name: MONICA L SANTOS
Title or Position: OWNER
Credential: PHD, BCBA
Phone: 860-531-9621