Active NPI
Glenroy Patrick Patterson, BCBA
- Behavior Analyst
- East Hartford, CT
National Provider Identifier
1063754653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-12-11741
- Practice address
- 72 Birchwood Rd
East Hartford, CT 06118-1702 - Phone
- (860) 206-9884
- Fax
- (860) 812-2399
- NPI assigned
- Mar 21, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Behavior Analyst | 103K00000X | 1-12-11741 | Primary |
Addresses
Primary practice location
72 Birchwood Rd
East Hartford, CT 06118-1702
Mailing address
72 Birchwood Rd
East Hartford, CT 06118-1702
Phone (860) 383-4423
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110026265 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trading Spaces ABA, LLC | Current | Accepting new patients | |
| Trading Spaces ABA, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Glastonbury, CT
- NPI 1205219060
-
- Behavior Analyst
- East Hartford, CT
- NPI 1417325374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1063754653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 BIRCHWOOD RD",
"city": "EAST HARTFORD",
"state": "CT",
"postal_code": "061181702",
"telephone_number": "860-383-4423",
"fax_number": "860-383-4423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 BIRCHWOOD RD",
"city": "EAST HARTFORD",
"state": "CT",
"postal_code": "061181702",
"telephone_number": "860-206-9884",
"fax_number": "860-812-2399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "GLENROY",
"middle_name": "PATRICK",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-21",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-12-11741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110026265",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.