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General NPI Number Information
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NPI Number | 1093367633
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Entity Type | Organization
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Legal Business Name | INNOVATIVE BEHAVIORAL MEDICINE LLC
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Dates
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Enumeration Date | 07/13/2019
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Last Update Date | 07/13/2019
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Provider Practice Location Address
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Address Line | 201 PENN CENTER BLVD STE 457
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City | PITTSBURGH
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State | PA
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Zip | 15235-5435
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Country | US
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Telephone | 412-439-1251
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Fax | 412-291-3003
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Provider Business Mailing Address
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Address Line | 201 PENN CENTER BLVD STE 457
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City | PITTSBURGH
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State | PA
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Zip | 15235-5435
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Country | US
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Telephone | 412-439-1251
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Fax | 412-291-3003
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Authorized Official
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Title or Position | CFO
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Name | CHRISTOPHER J GOISSE
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Credential | MBA
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Telephone | 724-984-8645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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