Healthcare Provider Details

I. General information

NPI: 1538643960
Provider Name (Legal Business Name): KSM BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 SUMMER ST FL 3
STAMFORD CT
06905-5016
US

IV. Provider business mailing address

1867 SUMMER ST FL 3
STAMFORD CT
06905-5016
US

V. Phone/Fax

Practice location:
  • Phone: 203-989-4725
  • Fax:
Mailing address:
  • Phone: 203-989-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KERRI S MORRIS
Title or Position: SOLE MEMBER
Credential: PH.D.
Phone: 203-895-6979