Provider Demographics
NPI:1932480464
Name:CENTRAL BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTRAL BEHAVIORAL HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-460-8461
Mailing Address - Street 1:41 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3633
Mailing Address - Country:US
Mailing Address - Phone:860-276-9295
Mailing Address - Fax:860-276-9296
Practice Address - Street 1:41 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3633
Practice Address - Country:US
Practice Address - Phone:860-276-9295
Practice Address - Fax:860-276-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty