1790694487 NPI number — LITTLE HAVEN BEHAVIORAL HEALTH CT LLC

Table of content: (NPI 1790694487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790694487 NPI number — LITTLE HAVEN BEHAVIORAL HEALTH CT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE HAVEN BEHAVIORAL HEALTH CT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790694487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 FOREST RD STE 316-240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10950-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-500-5779
Provider Business Mailing Address Fax Number:
201-987-5100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2389 MAIN AT
Provider Second Line Business Practice Location Address:
ATE 100
Provider Business Practice Location Address City Name:
GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-269-0886
Provider Business Practice Location Address Fax Number:
201-987-5100
Provider Enumeration Date:
09/07/2026

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
347-671-7627

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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