Provider Demographics
NPI:1487155560
Name:INTEGRATED ABA
Entity type:Organization
Organization Name:INTEGRATED ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTEINSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-716-4192
Mailing Address - Street 1:54 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3812
Mailing Address - Country:US
Mailing Address - Phone:860-716-4192
Mailing Address - Fax:
Practice Address - Street 1:54 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3812
Practice Address - Country:US
Practice Address - Phone:860-716-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty