Provider Demographics
NPI:1003380130
Name:THE CENTER FOR PEDIATRIC AND FAMILY GROWTH
Entity Type:Organization
Organization Name:THE CENTER FOR PEDIATRIC AND FAMILY GROWTH
Other - Org Name:THE CENTER FOR PEDIATRIC AND FAMILY GROWTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:203-722-9920
Mailing Address - Street 1:49 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3113
Mailing Address - Country:US
Mailing Address - Phone:203-722-9920
Mailing Address - Fax:
Practice Address - Street 1:49 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3113
Practice Address - Country:US
Practice Address - Phone:203-722-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33290OtherBACB
CTBA.000750OtherDEPARTMENT PUBLIC HEALTH
1326510777OtherNPI