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General NPI Number Information
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NPI Number | 1770236424
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 213 COURT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3346
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Country | US
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Telephone | 860-638-5309
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Fax | 860-638-5302
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Provider Business Mailing Address
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Address Line | 213 COURT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3346
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Country | US
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Telephone | 860-638-5309
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Fax | 860-638-5302
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | SAMUEL MOY
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Credential | PH.D.
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Telephone | 860-638-5309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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