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General NPI Number Information
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NPI Number | 1205643764
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Entity Type | Organization
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Legal Business Name | CHANNEL BEHAVIORAL CARE VA LLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 425 W WASHINGTON ST STE 4
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City | SUFFOLK
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State | VA
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Zip | 23434-5320
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Country | US
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Telephone | 646-238-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 7202 FORT HAMILTON PKWY
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City | BROOKLYN
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State | NY
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Zip | 11228-1906
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Country | US
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Telephone | 646-238-4930
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SIMCHA SILBERMAN
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Credential |
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Telephone | 646-238-4930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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