Provider Demographics
NPI:1336330422
Name:MCB BEHAVIORAL HEALTH, P.L.L.C.
Entity Type:Organization
Organization Name:MCB BEHAVIORAL HEALTH, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELVEDERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-426-7800
Mailing Address - Street 1:503 CENTRE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3444
Mailing Address - Country:US
Mailing Address - Phone:859-426-7800
Mailing Address - Fax:859-426-7804
Practice Address - Street 1:503 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-426-7800
Practice Address - Fax:859-426-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11585564OtherCAQH
KY89000863Medicaid
KY000000343674OtherANTHEM BEHAVIORAL HEALTH
KY89000863Medicaid