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General NPI Number Information
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NPI Number | 1427619626
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE ABA SERVICES, LLC
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 770 SAYBROOK RD UNIT B4
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4739
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Country | US
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Telephone | 860-421-4052
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Fax | 860-421-4053
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Provider Business Mailing Address
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Address Line | 770 SAYBROOK RD UNIT B4
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4739
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Country | US
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Telephone | 860-421-4052
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Fax | 860-421-4053
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | ALISHA SIMPSON-WATT
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Credential | LCSW, BCBA, LBA
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Telephone | 860-740-2547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 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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Taxonomy #3
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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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