Provider Demographics
NPI:1508061961
Name:ALLIANCE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:ALLIANCE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-405-0222
Mailing Address - Street 1:481 GOLD STAR HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6224
Mailing Address - Country:US
Mailing Address - Phone:860-405-0222
Mailing Address - Fax:860-405-1910
Practice Address - Street 1:481 GOLD STAR HWY STE 301
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6224
Practice Address - Country:US
Practice Address - Phone:860-405-0222
Practice Address - Fax:860-405-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-17
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003524Medicare PIN