Basic Information
| Provider Information | |||||||||
| NPI: | 1689926206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL DOTTORE CARE SOLUTIONS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28800 RYAN RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480924272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866208100 | ||||||||
| FaxNumber: | 8662277418 | ||||||||
| Practice Location | |||||||||
| Address1: | 36304 SHADY OAKS DR | ||||||||
| Address2: | |||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335258546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063652523 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2012 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | CLEMENTE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5866208108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.