=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639901234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A BRIGHTER WAY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2024
-----------------------------------------------------
Last Update Date | 09/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 152 SILVER SPRINGS DR
-----------------------------------------------------
City | HIGGANUM
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06441-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-316-7437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 SILVER SPRINGS DR
-----------------------------------------------------
City | HIGGANUM
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06441-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-316-7437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/BCBA
-----------------------------------------------------
Name | MRS. SAMANTHA ARESCO
-----------------------------------------------------
Credential | M.S, BCBA, LBA
-----------------------------------------------------
Telephone | 860-316-7437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------