Provider Demographics
NPI:1386782977
Name:APPLIED BEHAVIORAL SCIENCES LLC
Entity type:Organization
Organization Name:APPLIED BEHAVIORAL SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:RADASCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-236-7333
Mailing Address - Street 1:68 S MAIN ST BSMT 100
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2430
Mailing Address - Country:US
Mailing Address - Phone:860-236-7333
Mailing Address - Fax:203-439-2087
Practice Address - Street 1:68 S MAIN ST BSMT 100
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2430
Practice Address - Country:US
Practice Address - Phone:860-236-7333
Practice Address - Fax:203-439-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002295103TC0700X
CT002394103TF0200X
CT0063851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03708Medicare PIN