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General NPI Number Information
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NPI Number | 1366792178
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL DOTTORE CARE SOLUTIONS, INC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 4630 HANLEY RD
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City | CINCINNATI
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State | OH
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Zip | 45247-3533
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Country | US
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Telephone | 586-620-8100
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Fax | 866-227-7418
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Provider Business Mailing Address
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Address Line | 28800 RYAN RD SUITE 320
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City | WARREN
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State | MI
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Zip | 48092-4272
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Country | US
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Telephone | 586-620-8100
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Fax | 866-227-7418
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT A CLEMENTE
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Credential |
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Telephone | 586-620-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical 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 | 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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