Provider Demographics
NPI:1811387012
Name:BEHAVIOR SERVICES OF NEW ENGLAND
Entity Type:Organization
Organization Name:BEHAVIOR SERVICES OF NEW ENGLAND
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, BCBA-D
Authorized Official - Phone:860-315-0565
Mailing Address - Street 1:185 FABYAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1506
Mailing Address - Country:US
Mailing Address - Phone:860-315-0565
Mailing Address - Fax:860-315-0565
Practice Address - Street 1:185 FABYAN RD
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-1506
Practice Address - Country:US
Practice Address - Phone:860-315-0565
Practice Address - Fax:860-315-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002562251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1851572598Medicaid