Provider Demographics
NPI:1326348244
Name:PROGRAM BUILDERS, INC.
Entity Type:Organization
Organization Name:PROGRAM BUILDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERUSIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:860-295-0366
Mailing Address - Street 1:3 E HAMPTON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1447
Mailing Address - Country:US
Mailing Address - Phone:860-295-0366
Mailing Address - Fax:
Practice Address - Street 1:3 E HAMPTON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1447
Practice Address - Country:US
Practice Address - Phone:860-295-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1084608103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty