Provider Demographics
NPI:1811937139
Name:HALL-BROOKE BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:HALL-BROOKE BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-221-8801
Mailing Address - Street 1:47 LONG LOTS ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3828
Mailing Address - Country:US
Mailing Address - Phone:203-221-8801
Mailing Address - Fax:203-227-0547
Practice Address - Street 1:47 LONG LOTS ROAD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3828
Practice Address - Country:US
Practice Address - Phone:203-221-8801
Practice Address - Fax:203-227-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTH-0005261QM0850X, 261QM0855X
CTH0005283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT074000OtherLEGACY ID
CTC00051OtherPART B LEGACY NUMBER
CT074000Medicare Oscar/Certification