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General NPI Number Information
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NPI Number | 1255786638
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Entity Type | Organization
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Legal Business Name | THE VOGL PROGRAM
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 15 HAMMOCK PKWY
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City | CLINTON
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State | CT
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Zip | 06413
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Country | US
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Telephone | 860-391-5124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 219
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City | MADISON
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State | CT
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Zip | 06443-0219
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Country | US
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Telephone | 860-391-5124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW VOGL
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Credential | MA, BCBA
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Telephone | 860-391-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1-15-18792
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License Number State | CT
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