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General NPI Number Information
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NPI Number | 1831781954
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Entity Type | Organization
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Legal Business Name | ABC-CT,LLC
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 68 WILDEMERE AVE
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City | WATERBURY
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State | CT
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Zip | 06705-1838
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Country | US
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Telephone | 617-750-9398
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Fax | 203-841-1047
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Provider Business Mailing Address
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Address Line | 68 WILDEMERE AVE
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City | WATERBURY
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State | CT
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Zip | 06705-1838
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Country | US
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Telephone | 617-750-9398
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Fax | 203-841-1047
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Authorized Official
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Title or Position | CEO
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Name | MR. TAROLD MILLER
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Credential | M.ED.
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Telephone | 617-750-9398
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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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