Basic Information
| Provider Information | |||||||||
| NPI: | 1699143180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEURO BEHAVIORAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | SUITE # 15 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | SUITE # 15 | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086601666 | ||||||||
| FaxNumber: | 5086601667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2015 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | ABOU-ALLABAN | ||||||||
| AuthorizedOfficialFirstName: | YOUSEF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5086601666 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0402X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 2084P0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | 2084P0804X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0805X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.