NPIMap

Organization Active NPI

Trading Spaces ABA, LLC

  • Behavior Analyst
  • East Hartford, CT
National Provider Identifier
1417325374
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
11211741 Issued in FL
Legal business name
TRADING SPACES ABA, LLC
Practice address
72 Birchwood Rd
East Hartford, CT 06118-1702
Phone
(321) 914-7430
Fax
(860) 812-2399
NPI assigned
Sep 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

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

Authorized official

Name
Glenroy Patrick Patterson, BCBSNPI 1063754653
Title
Manager
Phone
(321) 914-7430

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 11211741 FL Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X CT

Addresses

Primary practice location

72 Birchwood Rd
East Hartford, CT 06118-1702

Mailing address

72 Birchwood Rd
East Hartford, CT 06118-1702
Phone (321) 914-7430

Other identifiers 1

IdentifierTypeStateIssuer
008059673MedicaidCT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1417325374",
    "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": "321-914-7430",
            "fax_number": "860-812-2399"
        },
        {
            "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": "321-914-7430",
            "fax_number": "860-812-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRADING SPACES ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "GLENROY",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-914-7430",
        "authorized_official_credential": "BCBS"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "11211741",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008059673",
            "state": "CT"
        }
    ],
    "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 Sep 9, 2015; 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.