Basic Information
| Provider Information | |||||||||
| NPI: | 1962838409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED HOUSE BEHAVIOR RESOURCES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 268 BUSH ST | ||||||||
| Address2: | #3039 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941043503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883623970 | ||||||||
| FaxNumber: | 5088827687 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 BUSH ST | ||||||||
| Address2: | #3039 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941043503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883623970 | ||||||||
| FaxNumber: | 5088827687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2013 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8883623970 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D., BCBA-D | ||||||||
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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 | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.