Organization
CT MC SPROUT 1 LLC
Active
Other names
Sprout Therapy, Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN SELZER (CHIEF FINANCIAL OFFICER)
(833) 991-2368
Entity
Organization
Contact information
Practice address
101 MERRITT 7 FL PARK3, NORWALK, CT 06851-1059
(833) 991-2368
(929) 384-7193
Mailing address
101 MERRITT 7 FL PARK3, NORWALK, CT 06851-1059
(833) 991-2368
(929) 384-7193
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
09/27/2021
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