Provider Demographics
NPI:1023557055
Name:ABA SERVICES OF CONNECTICUT, INC
Entity Type:Organization
Organization Name:ABA SERVICES OF CONNECTICUT, INC
Other - Org Name:APPLIED BEHAVIOR ANALYSIS SERVICES OF CT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR OF CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:570-417-1561
Mailing Address - Street 1:1261 BERLIN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:475-414-6699
Mailing Address - Fax:888-257-1805
Practice Address - Street 1:1261 BERLIN TURNPIKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:475-414-6699
Practice Address - Fax:888-257-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11212036251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health