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General NPI Number Information
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NPI Number | 1912206038
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Entity Type | Organization
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Legal Business Name | COMMUNITY BASED ADOLESCENT SERVICES, LLC
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 87 JONES ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-5435
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Country | US
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Telephone | 203-537-9811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | BRIDGEPORT
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State | CT
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Zip | 06601-0010
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Country | US
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Telephone |
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Fax | 203-937-8830
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. FRANK ANTHONY MASTRI
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Credential | LPC
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Telephone | 203-537-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001630
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License Number State | CT
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