Basic Information
| Provider Information | |||||||||
| NPI: | 1730451071 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COORDINATED BEHAVIORAL CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 WILLIAM STREET | ||||||||
| Address2: | 19TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469308803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 RECTOR ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100061705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123853030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2012 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | PETIT | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 6369308803 | ||||||||
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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 | 251B00000X | Y | Agencies | Case Management |
No ID Information.