Healthcare Provider Details

I. General information

NPI: 1386782977
Provider Name (Legal Business Name): APPLIED BEHAVIORAL SCIENCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S MAIN ST BSMT 100
WEST HARTFORD CT
06107-2430
US

IV. Provider business mailing address

68 S MAIN ST BSMT 100
WEST HARTFORD CT
06107-2430
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-7333
  • Fax: 203-439-2087
Mailing address:
  • Phone: 860-236-7333
  • Fax: 203-439-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002295
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number002394
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006385
License Number StateCT

VIII. Authorized Official

Name: DR. PETER D RADASCH
Title or Position: VICE PRESIDENT
Credential: PSY.D.
Phone: 860-236-7333