Healthcare Provider Details

I. General information

NPI: 1720344120
Provider Name (Legal Business Name): COORDINATED BEHAVIORAL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RECTOR ST 11TH FLOOR
NEW YORK NY
10006-1705
US

IV. Provider business mailing address

123 WILLIAM STREET 19TH FLOOR
NEW YORK NY
10038
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3030
  • Fax: 212-619-7275
Mailing address:
  • Phone: 646-930-8803
  • Fax: 212-619-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JORGE R PETIT
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 636-930-8803