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General NPI Number Information
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NPI Number | 1245786003
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Entity Type | Organization
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Legal Business Name | QUANTUM BEHAVIORAL CONSULTING, LLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 163 LEAD MINE BROOK RD
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City | HARWINTON
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State | CT
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Zip | 06791-1315
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Country | US
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Telephone | 860-338-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 163 LEADMINE BROOK ROAD
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City | HARWINTON
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State | CT
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Zip | 06791
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Country | US
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Telephone | 860-338-3130
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/SENIOR BEHAVIOR ANLAYST
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Name | MR. SCOTT ALLYN RODERICK
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Credential | BCBA
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Telephone | 860-338-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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