Healthcare Provider Details

I. General information

NPI: 1346835790
Provider Name (Legal Business Name): SR BEHAVIOR CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CABLES AVE APT 2
WATERBURY CT
06710-1644
US

IV. Provider business mailing address

47 BUCKINGHAM ST # F1
WATERBURY CT
06710-1900
US

V. Phone/Fax

Practice location:
  • Phone: 917-862-9389
  • Fax:
Mailing address:
  • Phone: 917-862-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH GOLDBERG
Title or Position: BCBA LBA
Credential:
Phone: 917-862-9389