Provider Demographics
NPI:1023322617
Name:ADVANCE BIRTH TO THREE
Entity type:Organization
Organization Name:ADVANCE BIRTH TO THREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-577-3700
Mailing Address - Street 1:590 MIDDLEBURY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2562
Mailing Address - Country:US
Mailing Address - Phone:203-577-3700
Mailing Address - Fax:203-577-3800
Practice Address - Street 1:590 MIDDLEBURY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2562
Practice Address - Country:US
Practice Address - Phone:203-577-3700
Practice Address - Fax:203-577-3800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE THERAPY ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency