CT MC Sprout 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

CT MC SPROUT 1 LLC

Practice address

101 Merritt 7 FL Park3
Norwalk, CT 06851-1059

Phone

(833) 991-2368

Fax

(929) 384-7193

NPI assigned

Jun 16, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin Selzer

Title

Chief Financial Officer

Phone

(833) 991-2368

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1235755174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MERRITT 7 FL PARK3",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511059",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MERRITT 7 FL PARK3",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511059",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CT MC SPROUT 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-16",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "SELZER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "833-991-2368"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Behavior Analyst in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.