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General NPI Number Information
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NPI Number | 1083052468
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Entity Type | Organization
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Legal Business Name | ADA THERAPY, LLC
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 333 BENNETT ST
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City | FAIRFIELD
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State | CT
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Zip | 06825-1375
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Country | US
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Telephone | 203-540-5186
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Fax |
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Provider Business Mailing Address
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Address Line | 333 BENNETT ST
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City | FAIRFIELD
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State | CT
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Zip | 06825-1375
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Country | US
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Telephone | 203-540-5186
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL JOSEPH WEISS
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Credential | PH.D.
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Telephone | 203-540-5186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 003214
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 003214
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 003214
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003214
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 003214
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 003214
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License Number State | CT
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