Provider Demographics
NPI:1043613706
Name:CONSTELLATIONS BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:CONSTELLATIONS BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEALD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BCBA
Authorized Official - Phone:800-778-5560
Mailing Address - Street 1:200 GRIFFIN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7145
Mailing Address - Country:US
Mailing Address - Phone:800-778-5560
Mailing Address - Fax:800-778-5560
Practice Address - Street 1:200 GRIFFIN RD STE 5
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7145
Practice Address - Country:US
Practice Address - Phone:800-778-5560
Practice Address - Fax:800-778-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty