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General NPI Number Information
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NPI Number | 1427821800
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL CONSULTING LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 76 WESTBURY PARK RD # 306E
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City | WATERTOWN
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State | CT
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Zip | 06795-2779
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Country | US
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Telephone | 203-522-7559
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Fax |
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Provider Business Mailing Address
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Address Line | 96 TODD HILL RD
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City | BETHLEHEM
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State | CT
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Zip | 06751-1018
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Country | US
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Telephone | 203-939-3271
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIELLE TESTA
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Credential | BCBA
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Telephone | 203-522-7559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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