Provider Demographics
NPI:1700324159
Name:MILESTONES BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:MILESTONES BEHAVIORAL SERVICES, INC.
Other - Org Name:CONNECTICUT CENTER FOR CHILD DEVELOPMENT, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LETSO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:203-882-8810
Mailing Address - Street 1:95 WOLF HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1938
Mailing Address - Country:US
Mailing Address - Phone:203-882-8810
Mailing Address - Fax:203-878-9468
Practice Address - Street 1:339 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3560
Practice Address - Country:US
Practice Address - Phone:203-882-8810
Practice Address - Fax:203-878-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01-03-1119103K00000X
CT3560103T00000X
CT0-15-6909106E00000X
CTRBT-15-08925106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty