Organization
TRADING SPACES ABA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENROY PATRICK PATTERSON BCBS (MANAGER)
(321) 914-7430
Entity
Organization
Contact information
Practice address
72 BIRCHWOOD RD, EAST HARTFORD, CT 06118-1702
(321) 914-7430
(860) 812-2399
Mailing address
72 BIRCHWOOD RD, EAST HARTFORD, CT 06118-1702
(321) 914-7430
(860) 812-2399
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11211741
FL
225X00000X
Occupational Therapist
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008059673
—
CT
Enumeration date
09/09/2015
Last updated
09/09/2015
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