| Trading Spaces Aba, Llc | |
|
72 Birchwood Rd East Hartford CT 06118-1702 | |
| (321) 914-7430 | |
| (860) 812-2399 |
| Full Name | Trading Spaces Aba, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 72 Birchwood Rd, East Hartford, Connecticut |
| Authorized Official Name and Position | Glenroy Patrick Patterson (MANAGER) |
| Authorized Official Contact | 3219147430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trading Spaces Aba, Llc 72 Birchwood Rd East Hartford CT 06118-1702 Ph: (321) 914-7430 | Trading Spaces Aba, Llc 72 Birchwood Rd East Hartford CT 06118-1702 Ph: (321) 914-7430 |
| NPI Number | 1417325374 |
|---|---|
| Provider Enumeration Date | 09/09/2015 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417325374 | NPI | - | NPPES |
| 008059673 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 11211741 (Florida) | Primary |
| 225X00000X | Occupational Therapist | (Connecticut) | Secondary |
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