Provider Demographics
NPI:1407147606
Name:INTEGRATED BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMAREE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN, BSN
Authorized Official - Phone:978-807-2673
Mailing Address - Street 1:5 EDGELL RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4874
Mailing Address - Country:US
Mailing Address - Phone:978-807-2673
Mailing Address - Fax:
Practice Address - Street 1:5 EDGELL RD
Practice Address - Street 2:SUITE 27
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4874
Practice Address - Country:US
Practice Address - Phone:978-807-2673
Practice Address - Fax:774-987-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6439261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1898906Medicaid
MAW05257Medicare UPIN