Healthcare Provider Details

I. General information

NPI: 1548867799
Provider Name (Legal Business Name): CROSS RIVER THERAPY IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256-3387
US

IV. Provider business mailing address

740 CEDAR LAWN AVE
FAR ROCKAWAY NY
11691-5304
US

V. Phone/Fax

Practice location:
  • Phone: 919-375-0475
  • Fax: 919-928-5528
Mailing address:
  • Phone: 919-375-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ZAUDERER
Title or Position: CEO
Credential:
Phone: 919-375-0475