Provider Demographics
NPI:1053021212
Name:REACH TO BE LIMITED LIABILITY
Entity type:Organization
Organization Name:REACH TO BE LIMITED LIABILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-834-2368
Mailing Address - Street 1:34-3 SHUNPIKE RD # 218
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2490
Mailing Address - Country:US
Mailing Address - Phone:860-834-2368
Mailing Address - Fax:866-734-8280
Practice Address - Street 1:34-3 SHUNPIKE RD # 218
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2490
Practice Address - Country:US
Practice Address - Phone:860-834-2368
Practice Address - Fax:866-734-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty