Provider Demographics
NPI:1912206038
Name:COMMUNITY BASED ADOLESCENT SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY BASED ADOLESCENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MASTRI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-537-9811
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06601-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:203-937-8830
Practice Address - Street 1:87 JONES ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5435
Practice Address - Country:US
Practice Address - Phone:203-537-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty