Healthcare Provider Details

I. General information

NPI: 1720542830
Provider Name (Legal Business Name): FAMILYCARE BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 SNELL AVE # 451
SAN JOSE CA
95123-3328
US

IV. Provider business mailing address

5669 SNELL AVE # 451
SAN JOSE CA
95123-3328
US

V. Phone/Fax

Practice location:
  • Phone: 408-835-0048
  • Fax: 650-434-0749
Mailing address:
  • Phone: 408-835-0048
  • Fax: 650-434-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN M PETRICK
Title or Position: PRESIDENT
Credential: BCBA
Phone: 408-835-0048