Provider Demographics
NPI:1851860696
Name:ALLY BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:ALLY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TODISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, BCBA
Authorized Official - Phone:508-695-3950
Mailing Address - Street 1:1 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02763-1119
Mailing Address - Country:US
Mailing Address - Phone:508-695-3950
Mailing Address - Fax:508-318-5255
Practice Address - Street 1:1 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02763-1119
Practice Address - Country:US
Practice Address - Phone:508-695-3950
Practice Address - Fax:508-318-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty