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Organization
FUN 2B FREE LLC
Active
Organization
FUN 2B FREE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY JACKSON MBA, BCBA, LBA (OWNER)
(203) 819-2025
Entity
Organization
Contact information
Practice address
150 VICTORIA DR, CHESHIRE, CT 06410-7126
(203) 819-2025
Mailing address
150 VICTORIA DR, CHESHIRE, CT 06410-7126
(203) 819-2025
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
171000000X
Military Health Care Provider
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1251258
STATE INCOME ID
CT
Enumeration date
10/02/2020
Last updated
10/02/2020
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