Provider Demographics
NPI:1205219060
Name:TRADING SPACES ABA, LLC
Entity Type:Organization
Organization Name:TRADING SPACES ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENROY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-430-1340
Mailing Address - Street 1:2800 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1080
Mailing Address - Country:US
Mailing Address - Phone:860-430-1340
Mailing Address - Fax:860-812-2399
Practice Address - Street 1:437 NAUBUC AVE
Practice Address - Street 2:STE. 105
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1080
Practice Address - Country:US
Practice Address - Phone:321-914-7430
Practice Address - Fax:660-812-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care