Provider Demographics
NPI:1154804201
Name:BEHAVIOR ANALYTIC SERVICES OF CONNECTICUT, LLC
Entity type:Organization
Organization Name:BEHAVIOR ANALYTIC SERVICES OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WINEBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:203-525-6696
Mailing Address - Street 1:36 N PROSPECT STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-3023
Mailing Address - Country:US
Mailing Address - Phone:203-525-6696
Mailing Address - Fax:
Practice Address - Street 1:36 N PROSPECT STREET EXT
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-3023
Practice Address - Country:US
Practice Address - Phone:203-525-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty