Basic Information
| Provider Information | |||||||||
| NPI: | 1144885468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUVO BEHAVIORAL HEALTH OF CONNECTICUT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 UNIVERSITY PLZ STE 500 | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076016203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014705754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 157 CHURCH ST FL 19 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108324383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCHREIBER | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2014705752 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.