Provider Demographics
NPI:1699800045
Name:ROBERT W BEHRENDS LLC
Entity type:Organization
Organization Name:ROBERT W BEHRENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEHRENDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-597-0633
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-597-0633
Mailing Address - Fax:203-755-5977
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-597-0633
Practice Address - Fax:203-755-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010020493CT02OtherANTHEM BCBS
CT010020493CT02OtherANTHEM BCBS
CTE05774Medicare UPIN