Provider Demographics
NPI:1619242658
Name:GREEN VALLEY BEHAVIOR ANALYSTS, LLC
Entity Type:Organization
Organization Name:GREEN VALLEY BEHAVIOR ANALYSTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR; CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:860-315-0565
Mailing Address - Street 1:687 N WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2941
Mailing Address - Country:US
Mailing Address - Phone:860-315-0565
Mailing Address - Fax:508-764-1703
Practice Address - Street 1:687 N WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2941
Practice Address - Country:US
Practice Address - Phone:860-315-0565
Practice Address - Fax:508-764-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health