Healthcare Provider Details

I. General information

NPI: 1669884409
Provider Name (Legal Business Name): COGNITIVE BEHAVIOR INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 MACKENZIE WAY SUITE 100
CRANBERRY TWP PA
16066-5332
US

IV. Provider business mailing address

168 SOUTHRIDGE DR
CRANBERRY TWP PA
16066-2404
US

V. Phone/Fax

Practice location:
  • Phone: 724-814-9708
  • Fax:
Mailing address:
  • Phone: 724-814-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017308
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KEVIN CARIDAD
Title or Position: FOUNDER / DIRECTOR
Credential: LCSW
Phone: 724-814-9708