Provider Demographics
NPI:1376785808
Name:ENHANCING BEHAVIORAL CHOICES
Entity Type:Organization
Organization Name:ENHANCING BEHAVIORAL CHOICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ENHANCING BEHAVIORAL CHOICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SURWILO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-289-4404
Mailing Address - Street 1:1169 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3515
Mailing Address - Country:US
Mailing Address - Phone:860-289-4404
Mailing Address - Fax:860-289-4402
Practice Address - Street 1:1169 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3515
Practice Address - Country:US
Practice Address - Phone:860-289-4404
Practice Address - Fax:860-289-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X, 103TC0700X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty