Provider Demographics
NPI:1225567209
Name:CHICKADEE BEHAVIORAL CONSULTING, LLC
Entity Type:Organization
Organization Name:CHICKADEE BEHAVIORAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:PASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:MAPSYCH, BCBA
Authorized Official - Phone:203-240-0174
Mailing Address - Street 1:696 CHICKADEE LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2410
Mailing Address - Country:US
Mailing Address - Phone:203-240-0174
Mailing Address - Fax:
Practice Address - Street 1:696 CHICKADEE LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-2410
Practice Address - Country:US
Practice Address - Phone:203-240-0174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-13-13804103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty