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General NPI Number Information
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NPI Number | 1902888449
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Entity Type | Organization
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Legal Business Name | EASTER SEALS CONNECTICUT INC.
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 733 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06901-1081
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Country | US
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Telephone | 860-242-2274
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Fax | 860-769-6564
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Provider Business Mailing Address
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Address Line | 120 HOLCOMB ST
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City | HARTFORD
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State | CT
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Zip | 06112-1529
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Country | US
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Telephone | 860-242-2274
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Fax | 860-769-6564
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. BARRY M SIMON
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Credential |
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Telephone | 860-769-3901
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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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