Basic Information
| Provider Information | |||||||||
| NPI: | 1053772426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEURO BEHAVIORAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 MAIN ST STE 15 | ||||||||
| Address2: | |||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | ABOU-ALLABAN | ||||||||
| AuthorizedOfficialFirstName: | YOUSEF | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5086601666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 103TC2200X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 2080P0006X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.