Healthcare Provider Details

I. General information

NPI: 1114638178
Provider Name (Legal Business Name): CHANNEL BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 05/29/2024
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 FORT HAMILTON PKWY
BROOKLYN NY
11228-1906
US

IV. Provider business mailing address

7202 FORT HAMILTON PKWY
BROOKLYN NY
11228-1906
US

V. Phone/Fax

Practice location:
  • Phone: 646-238-4930
  • Fax:
Mailing address:
  • Phone: 646-238-4930
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. SIM SILBERMAN
Title or Position: CEO
Credential:
Phone: 646-238-4930