Healthcare Provider Details

I. General information

NPI: 1427444520
Provider Name (Legal Business Name): ABA OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WOODGLEN LN APT 201
DOWNERS GROVE IL
60516-4525
US

IV. Provider business mailing address

8200 WOODGLEN LN APT 201
DOWNERS GROVE IL
60516-4525
US

V. Phone/Fax

Practice location:
  • Phone: 602-471-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ERIN M RABER
Title or Position: ADMIN COORDINATOR
Credential:
Phone: 602-471-6802