Provider Demographics
NPI:1811653447
Name:GREAT AMBITIONS, LLC
Entity type:Organization
Organization Name:GREAT AMBITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:ZEF
Authorized Official - Last Name:DUSI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:917-804-3106
Mailing Address - Street 1:95 GLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2424
Mailing Address - Country:US
Mailing Address - Phone:917-804-3106
Mailing Address - Fax:
Practice Address - Street 1:95 GLEN HILL RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2424
Practice Address - Country:US
Practice Address - Phone:917-804-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health