Provider Demographics
NPI:1578134987
Name:EVIDENCE BASED SERVICES LLC CONNECTICUT DIVISION
Entity Type:Organization
Organization Name:EVIDENCE BASED SERVICES LLC CONNECTICUT DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-234-2764
Mailing Address - Street 1:222 BEAVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-1236
Mailing Address - Country:US
Mailing Address - Phone:860-234-2764
Mailing Address - Fax:
Practice Address - Street 1:222 BEAVER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06256-1236
Practice Address - Country:US
Practice Address - Phone:860-234-2764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health