Provider Demographics
NPI:1770236424
Name:ADVANCED BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-638-5309
Mailing Address - Street 1:213 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3346
Mailing Address - Country:US
Mailing Address - Phone:860-638-5309
Mailing Address - Fax:860-638-5302
Practice Address - Street 1:213 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3346
Practice Address - Country:US
Practice Address - Phone:860-638-5309
Practice Address - Fax:860-638-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNONEOtherNONE