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General NPI Number Information
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NPI Number | 1407399660
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Entity Type | Organization
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Legal Business Name | AUTISM BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 100 RESERVE RD STE F300
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-429-5318
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Fax | 203-628-4388
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Provider Business Mailing Address
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Address Line | 100 RESERVE RD STE F300
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-429-5318
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Fax | 203-628-4388
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JESSIE WONG
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Credential | BCBA, LBA
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Telephone | 203-884-1268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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