MEDICARE: COMMONWEALTH BEHAVIORAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1588446231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH BEHAVIORAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	6705 CASTLEWOOD CIR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3016
Country	:	US
Telephone Number	:	757-634-7550
Fax Number	:

Provider Business Practice Location Address
First Line	:	12828 WILLOW CENTRE DR STE D26
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3043
Country	:	US
Telephone Number	:	757-634-7550
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BEN FITZGERALD
Credential	:
Telephone Number	:	757-634-7550

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/24/2023

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