MEDICARE: UNIVERSITY BEHAVIORAL ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1760756852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY BEHAVIORAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	111 E 210TH ST
Second Line	:	ATTN: SCOTT WETZLER, PHD
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:	718-920-4920
Fax Number	:	718-798-1816

Provider Business Practice Location Address
First Line	:	334 E 148TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5707
Country	:	US
Telephone Number	:	718-401-6060
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. SCOTT WETZLER
Credential	:	PHD
Telephone Number	:	718-920-4920

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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