Provider Demographics
NPI:1164738654
Name:CENTER FOR DEVELOPMENTAL & BEHAVIORAL THERAPY, LLC
Entity Type:Organization
Organization Name:CENTER FOR DEVELOPMENTAL & BEHAVIORAL THERAPY, LLC
Other - Org Name:CDBT
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-349-7857
Mailing Address - Street 1:475 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-7837
Mailing Address - Country:US
Mailing Address - Phone:303-644-3353
Mailing Address - Fax:
Practice Address - Street 1:475 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-7837
Practice Address - Country:US
Practice Address - Phone:303-349-7857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4913251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health