Healthcare Provider Details

I. General information

NPI: 1851860696
Provider Name (Legal Business Name): ALLY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTH AVE
NORTH ATTLEBORO MA
02763-1119
US

IV. Provider business mailing address

1 NORTH AVE
NORTH ATTLEBORO MA
02763-1119
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-3950
  • Fax: 508-318-5255
Mailing address:
  • Phone: 508-695-3950
  • Fax: 508-318-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY JAMES TODISCO
Title or Position: OWNER/PRESIDENT
Credential: LMHC, BCBA
Phone: 508-695-3950