Provider Demographics
NPI:1114415254
Name:CBT WESTPORT LLC
Entity Type:Organization
Organization Name:CBT WESTPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CTO
Authorized Official - Prefix:DR
Authorized Official - First Name:VATSAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-292-0344
Mailing Address - Street 1:1720 POST RD E STE 223
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5643
Mailing Address - Country:US
Mailing Address - Phone:203-220-6486
Mailing Address - Fax:203-220-6487
Practice Address - Street 1:1720 POST RD E STE 223
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5643
Practice Address - Country:US
Practice Address - Phone:203-220-6486
Practice Address - Fax:203-220-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty