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General NPI Number Information
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NPI Number | 1013450352
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Entity Type | Organization
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Legal Business Name | GAIN BEHAVIOR
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 145 36TH AVE NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-1433
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Country | US
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Telephone | 845-521-5830
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Fax |
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Provider Business Mailing Address
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Address Line | 145 36TH AVE NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-1433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEANNE SIMON
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Credential |
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Telephone | 845-521-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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