Provider Demographics
NPI:1679334346
Name:RISE ABOVE BEHAVIORAL GROUP CT LLC
Entity Type:Organization
Organization Name:RISE ABOVE BEHAVIORAL GROUP CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:ACEVEDO
Authorized Official - Last Name:USUGA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:475-235-5709
Mailing Address - Street 1:180 NE 29TH ST APT 903
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5236
Mailing Address - Country:US
Mailing Address - Phone:475-235-5709
Mailing Address - Fax:305-564-6762
Practice Address - Street 1:76 WESTBURY PARK RD STE 306E
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2779
Practice Address - Country:US
Practice Address - Phone:305-317-2818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RISE ABOVE BEHAVIORAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty