MEDICARE: BEHAVIORAL MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710004908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	156 COW HILL RD
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-1110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 QUINNIPIAC AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3904
Country	:	US
Telephone Number	:	860-663-0401
Fax Number	:	860-663-0400

Authorized Official
Title or Position	:	INSURANCE SPECIALIST
Name	:	DAWN MATHIEU
Credential	:
Telephone Number	:	860-663-0401

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/27/2007

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