Basic Information
| Provider Information | |||||||||
| NPI: | 1043613706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSTELLATIONS BEHAVIORAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GRIFFIN RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007785560 | ||||||||
| FaxNumber: | 8007785560 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 GRIFFIN RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007785560 | ||||||||
| FaxNumber: | 8007785560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2014 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | HEALD | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8007785560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA, BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.