Provider Demographics
NPI:1447440813
Name:ANXIETY TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:ANXIETY TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALTBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-269-7813
Mailing Address - Street 1:6 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1480
Mailing Address - Country:US
Mailing Address - Phone:860-269-7813
Mailing Address - Fax:860-269-8621
Practice Address - Street 1:6 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1480
Practice Address - Country:US
Practice Address - Phone:860-269-7813
Practice Address - Fax:860-269-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002464103TB0200X, 103TC0700X
CT2956103TB0200X, 103TC0700X
CT2878103TB0200X, 103TC0700X
CT3623103TB0200X, 103TC0700X
CT3478103TB0200X, 103TC0700X
CT2528103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty